Wang Jieying, Chen Zhuolin, Xu Yuni, Qiu Wenhua, Chen Shaowen, Pei Hua, Zhong Yeteng
Department of Clinical Laboratory, The Second Affiliated Hospital of Hainan Medical University, Haikou, People's Republic of China.
Infect Drug Resist. 2023 Jan 25;16:463-476. doi: 10.2147/IDR.S396050. eCollection 2023.
China has seen a drastic increase in the incidence of non-tuberculous mycobacteria (NTM) infection, which is a notable public health issue. Due to a lack of reliable epidemiological surveillance information, there is a need to gather accurate epidemiological and surveillance data, which can help clinicians effectively treat NTM patients. Moreover, drug susceptibility testing for NTM is not frequently performed in China. This retrospective study, therefore, determined the prevalence and resistance characteristics of NTM to provide a reference to control the NTM epidemic.
Sputum, alveolar lavage fluid, and other respiratory specimens were collected from 3025 patients with suspected pulmonary tuberculosis attending The Second Affiliated Hospital of Hainan Medical University from January 2014 to December 2021. Strain identification and species distribution of NTM were performed by DNA chip technology and gene sequencing, and the drug resistance of NTM isolates was evaluated by calculating the minimum inhibitory concentration through antimicrobial susceptibility testing for NTM.
From 2014 to 2021, 373 strains of NTM were isolated and identified from respiratory specimens of 3025 suspected tuberculosis patients. Except in 2014, NTM-infected patients accounted for more than 10% of suspected tuberculosis patients in other years. The median age of patients with NTM infection was 62.0 years (53.0, 71.0), and the male-to-female ratio among these patients was 0.79:1. Among culture-positive strains, 12.3% (373/3040; 95% CI 11.1-13.4%) were identified as NTM comprising forty species of NTM. The forty species of NTM included 23 slow-growing mycobacteria (SGM) and 17 rapidly-growing mycobacteria (RGM). Among the NTM isolates, 58.7% (219/373; 95% CI 53.7-63.7%) were SGM and 41.3% (154/373; 95% CI 36.3-46.3%) were RGM. complex(MAC)(41.3%; 95% CI 36.3-46.3%) and complex (MABC)(33.2%; 95% CI 28.4-38.0%) were the most frequently detected species, followed by Complex (11.8%; 95% CI 8.5-15.1%), group (5.1%; 95% CI 2.9-7.3%), and others. Drug sensitivity test results showed that most of the NTM isolates were susceptible to amikacin and clarithromycin with a drug resistance rate of less than 10%. However, clarithromycin could induce drug resistance, followed by linezolid and moxifloxacin, and their drug resistance rate was less than 50%.
During 2014-2021, the number of NTM isolates detected in the respiratory specimens of the study patients in The Second Affiliated Hospital of Hainan Medical University increased year by year. is the most common pathogenic NTM species, and there is a high incidence of NTM infection on Hainan Island. Our findings might be of great importance for diagnosing and treating this patient population in Hainan.
中国非结核分枝杆菌（NTM）感染的发病率急剧上升，这是一个显著的公共卫生问题。由于缺乏可靠的流行病学监测信息，需要收集准确的流行病学和监测数据，以帮助临床医生有效治疗NTM患者。此外，中国NTM的药敏试验并不经常进行。因此，本回顾性研究确定了NTM的患病率和耐药特征，为控制NTM流行提供参考。
收集2014年1月至2021年12月在海南医学院第二附属医院就诊的3025例疑似肺结核患者的痰液、肺泡灌洗液和其他呼吸道标本。采用DNA芯片技术和基因测序进行NTM的菌株鉴定和菌种分布，通过NTM抗菌药物敏感性试验计算最低抑菌浓度来评估NTM分离株的耐药性。
2014年至2021年，从3025例疑似结核病患者的呼吸道标本中分离并鉴定出373株NTM。除2014年外，其他年份NTM感染患者占疑似结核病患者的比例均超过10%。NTM感染患者的中位年龄为62.0岁（53.0，71.0），男女比例为0.79:1。在培养阳性菌株中，12.3%（373/3040；95%CI 11.1-13.4%）被鉴定为NTM，包括40种NTM。这40种NTM包括23种缓慢生长分枝杆菌（SGM）和17种快速生长分枝杆菌（RGM）。在NTM分离株中，58.7%（219/373；95%CI 53.7-63.7%）为SGM，41.3%（154/373；95%CI 36.3-46.3%）为RGM。鸟分枝杆菌复合群（MAC）（41.3%；95%CI 36.3-46.3%）和脓肿分枝杆菌复合群（MABC）（33.2%；95%CI 28.4-38.0%）是最常检测到的菌种，其次是堪萨斯分枝杆菌复合群（11.8%；95%CI 8.5-15.1%）、龟分枝杆菌群（5.1%；95%CI 2.9-7.3%）等。药敏试验结果显示，大多数NTM分离株对阿米卡星和克拉霉素敏感，耐药率低于10%。然而，克拉霉素可诱导耐药，其次是利奈唑胺和莫西沙星，其耐药率低于50%。
2014-2021年期间，海南医学院第二附属医院研究患者呼吸道标本中检测到的NTM分离株数量逐年增加。鸟分枝杆菌复合群是最常见的致病性NTM菌种，海南岛NTM感染发病率较高。我们的研究结果可能对海南该患者群体的诊断和治疗具有重要意义。
