体外评估 17 种抗临床鸟分枝杆菌复合体分离株的抗菌药物。
In vitro assessment of 17 antimicrobial agents against clinical Mycobacterium avium complex isolates.
机构信息
Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
BMC Microbiol. 2022 Jul 8;22(1):175. doi: 10.1186/s12866-022-02582-2.
BACKGROUND
Recently, Mycobacterium avium complex (MAC) infections have been increasing, especially in immunocompromised and older adults. The rapid increase has triggered a global health concern due to limited therapeutic strategies and adverse effects caused by long-term medication. To provide more evidence for the treatment of MAC, we studied the in vitro inhibitory activities of 17 antimicrobial agents against clinical MAC isolates.
RESULTS
A total of 111 clinical MAC isolates were enrolled in the study and they were identified as M. intracellulare, M. avium, M. marseillense, M. colombiense, M. yongonense, and two isolates could not be identified at the species level. MAC strains had relatively low (0-21.6%) resistance to clarithromycin, amikacin, bedaquiline, rifabutin, streptomycin, and clofazimine, and the resistant rates to isoniazid, rifampin, linezolid, doxycycline, and ethionamide were very high (72.1-100%). In addition, M. avium had a significantly higher resistance rate than that of M. intracellulare for ethambutol (92.3% vs 40.7%, P < 0.001), amikacin (15.4% vs 1.2%, P = 0.049), and cycloserine (69.2% vs 25.9%, P = 0.004).
CONCLUSIONS
Our results supported the current usage of macrolides, rifabutin, and aminoglycosides in the regimens for MAC infection, and also demonstrated the low resistance rate against new drugs, such as clofazimine, tedizolid, and bedaquiline, suggesting the possible implementation of these drugs in MAC treatment.
背景
近年来，鸟分枝杆菌复合群（MAC）感染呈上升趋势，尤其是在免疫功能低下和老年人中。由于治疗策略有限且长期用药会产生不良反应，这种快速增长引发了全球健康关注。为了提供更多 MAC 治疗的证据，我们研究了 17 种抗菌药物对临床 MAC 分离株的体外抑制活性。
结果
本研究共纳入 111 株临床 MAC 分离株，鉴定为细胞内分枝杆菌、鸟分枝杆菌、马赛分枝杆菌、哥伦比亚分枝杆菌、约氏分枝杆菌和 2 株不能鉴定到种的分枝杆菌。MAC 菌株对克拉霉素、阿米卡星、贝达喹啉、利福布汀、链霉素和氯法齐明的耐药率较低（0-21.6%），对异烟肼、利福平、利奈唑胺、强力霉素和乙胺丁醇的耐药率非常高（72.1-100%）。此外，鸟分枝杆菌对乙胺丁醇（92.3%比 40.7%，P<0.001）、阿米卡星（15.4%比 1.2%，P=0.049）和环丝氨酸（69.2%比 25.9%，P=0.004）的耐药率明显高于细胞内分枝杆菌。
结论
我们的研究结果支持大环内酯类、利福布汀和氨基糖苷类药物在 MAC 感染治疗方案中的应用，同时也证明了新型药物如氯法齐明、替加环素和贝达喹啉的耐药率较低，提示这些药物可能用于 MAC 的治疗。
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