杭州地区流行非结核分枝杆菌鉴定、易感因素和耐药性分析

发布时间：2018-12-08 12:36

【摘要】：目的了解近年杭州地区非结核分枝杆菌(NTM)感染、优势菌种及其耐药性。方法采用PNB/TCH生长试验对1 972例患者分枝杆菌阳性培养物标本中NTM进行初步鉴定。采用分枝杆菌分子线性探针法和16SrRNA基因PCR产物测序鉴定NTM菌种。分析性别和年龄对NTM易感性的影响。采用浓度比例法检测NTM分离菌株对异烟肼(INH)、利福平(RFP)、链霉素(SM)、乙胺丁醇(EMB)、氧氟沙星(OFX)、卡那霉素(KM)的敏感性。结果 9.8%(193/1 972)分枝杆菌阳性培养物标本PNB/TCH生长试验结果阳性。分子线性探针法和16SrRNA基因PCR产物测序结果显示,193例PNB/TCH生长试验阳性标本中,66.3%为单一NTM、18.1%为2种分枝杆菌、8.3%为结核分枝杆菌、7.3%为非分枝杆菌属细菌感染。173株NTM(单一感染128株+混合感染45株)中,胞内分枝杆菌占57.8%,其次为脓肿分枝杆菌、堪萨斯分枝杆菌、龟分枝杆菌和鸟分枝杆菌(12.1%、9.8%、9.8%和5.8%)。35例分枝杆菌混合感染标本中,28.5%和20.0%分别为胞内分枝杆菌或龟分枝杆菌与结核分枝杆菌混合感染。NTM感染者男性多于女性(1.67∶1),50岁以上人群感染率(80.4%)高于50岁以下人群(P0.01),肺部感染比例(95.1%)远高于其他部位(P0.01)。NTM分离株对INH耐药率为100%,对其他5种抗结核药物的耐药率也高达70.3%~90.6%。结论胞内分枝杆菌是杭州地区近年优势流行的NTM菌种,NTM主要引起肺部感染且中老年人易感,NTM临床菌株对常用抗结核药物有很高的耐药性。
[Abstract]:Objective to investigate the (NTM) infection, dominant species and drug resistance of non-tuberculosis mycobacteria in Hangzhou area in recent years. Methods PNB/TCH growth test was used to identify NTM in 1 972 cases of mycobacterium positive culture. The NTM strains were identified by using the molecular linear probe method of Mycobacterium and the sequencing of PCR products of 16SrRNA gene. To analyze the influence of sex and age on susceptibility to NTM. The sensitivity of NTM isolates to isoniazid (INH), rifampicin, (RFP), streptomycin, (SM), ethambutanol, (EMB), ofloxacin, (OFX), kanamycin (KM) was determined by concentration ratio method. Results PNB/TCH growth test was positive in 9.8% (19.3 / 1 972) mycobacterium positive cultures. The results of molecular linear probe method and PCR product sequencing of 16SrRNA gene showed that 66.3% of 193 PNB/TCH growth test positive specimens were single NTM,18.1%, 2 species of Mycobacterium tuberculosis, 8.3% of which were Mycobacterium tuberculosis. Of the 173 strains of NTM (45 strains of mixed infection), 57.8% were mycobacterium, followed by Mycobacterium abscess, Mycobacterium Kansas, Mycobacterium abscess, Mycobacterium Kansan, Mycobacterium abscess and Mycobacterium Kansa. Mycobacterium tortoise and Mycobacterium avium (12.1B 9.8m 9.8wt% and 5.8%). 35 specimens of mixed infection with Mycobacterium spp. 28.5% and 20.0% of the patients were infected with Mycobacterium endocytogenes or Mycobacterium tortoise and Mycobacterium tuberculosis respectively. There were more cases of NTM infection in males than in females (1.67: 1). The infection rate of people over 50 years old (80.4%) was higher than that of people under 50 years old (P0.01), and the rate of lung infection (95.1%) was much higher than that of other parts (P0.01). NTM isolates were resistant to INH 100%). The resistance rate to the other 5 anti-tuberculosis drugs was 70.3% and 90.6%. Conclusion Mycobacterium endocytogenes is the dominant NTM strain in Hangzhou area in recent years. NTM mainly causes pulmonary infection and is susceptible to middle and old people. NTM clinical strains have high resistance to common anti-tuberculosis drugs.
【作者单位】：杭州市疾病预防控制中心;杭州医学院;
【基金】：浙江省卫生高层次创新人才培养工程项目(No.2012-241)资助~~
【分类号】：R446.5

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