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| 南京地区2017—2020年结核
及非结核分枝杆菌菌株分布及耐药情况分析 |
| Distribution and drug resistance analysis of Mycobacterium tuberculosis and nontuberculosis mycobacteria in Nanjing from 2017 to 2020 of hand-foot-mouth disease in Baoji, from 2010 to 2019 |
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| DOI：10.3969/j.issn.1007-8134.2022.03.015 |
| 中文关键词: 结核分枝杆菌 非结核分枝杆菌 抗结核药物 耐药性 菌种鉴定 药物敏感性试验 南京 |
| 英文关键词: Mycobacterium tuberculosis nontuberculosis mycobacteria anti-tuberculous drugs drug-resistance strain identification drug sensitivity test Nanjing |
| 基金项目:南京市卫生科技发展专项资金项目（YKK19113） |
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| 中文摘要: |
| [摘要]?目的?了解南京地区2017—2020年分枝杆菌临床分离菌株的分布及对常用抗结核药物的耐药性，为本地区结核病临床治疗提供实验室依据。方法?回顾性分析2017—2020年南京市第二医院检验检测中心分离培养的5018株分枝杆菌，经菌种鉴定和绝对浓度法药物敏感性试验，分析结核分枝杆菌（Mycobacterium tuberculosis, MTB）和非结核分枝杆菌（nontuberculosis mycobacteria, NTM）对9种抗结核药物的耐药性。结果 5018株分枝杆菌经初步菌种鉴定，3898株（77.7%）为MTB，1120株（22.3%）为NTM。其中619株NTM经进一步菌种鉴定判定主要为胞内分枝杆菌（Mycobacterium intracellulare, MIN），龟分枝杆菌脓肿亚种（Mycobacterium abscessus, MAB）和鸟分枝杆菌（Mycobacterium avium, MAV），分别有376株（60.7％），80株（12.9%）和66株（10.7%）。MTB对9种抗结核药物的耐药率，异烟肼最高（20.4%），卷曲霉素最低（2.2%），异烟肼、左氧氟沙星、卷曲霉素、对氨基水杨酸耐药率在2017—2020年均呈上升趋势（P均＜0.05）；4年间所有单耐药结核菌株（mono-resistant tuberculosis, MR-TB）、多耐药结核菌株（poly-drug resistant tuberculosis, PDR-TB）、耐多药结核菌株（multi-drug resistant tuberculosis, MDR-TB）、广泛耐药结核菌株（extensively-drug resistant tuberculosis, XDR-TB）占比分别为9.2％、6.5％、12.7％、2.2％，其中MR-TB、PDR-TB占比在2017—2020年间呈显著下降趋势（P均＜0.05），MDR-TB、XDR-TB占比在2017—2020年间呈显著上升趋势（P均＜0.05）。1120株NTM对纳入研究的9种抗结核药物均有不同程度的耐药。 结论?南京地区分枝杆菌感染以MTB为主，其中MDR-TB、XDR-TB占比呈显著上升趋势；NTM菌种主要是MIN，MAB和MAV，对抗结核药物普遍耐药。临床应加强对分枝杆菌的分离鉴定并密切监测相关菌株的耐药性，为有效控制分枝杆菌感染和进行针对性治疗提供理论依据。 |
| 英文摘要: |
| [Abstract] Objective?To analyze the distribution of the Mycobacterium clinical isolates and their drug resistance to commonly used anti-tuberculous drugs in Nanjing from 2017 to 2020, and to provide laboratory evidence for clinical treatment of tuberculosis in this area. Methods?A total of 5018 strains of Mycobacterium isolated and cultured in the Clinical Laboratory of Nanjing Second Hospital from 2017 to 2020 were retrospectively analyzed in this study, species identification and drug susceptibility test by absolute concentration method were performed to analyze the drug resistance of Mycobacterium tuberculosis (MTB) and nontuberculosis mycobacteria (NTM) against 9 anti-tuberculous drugs. Results?Three thousand eight hundred and ninety-eight of 5018 isolates were identified as MTB (77.7%), while the other 1120 were identified as NTM (22.3%). Six hundred and ninetee strains of 1120 NTM were further identified as 376 Mycobacterium intracellulare (MIN) (60.7%), 80 Mycobacterium abscessus (MAB) (12.9%), and 66 Mycobacterium avium (MAV) (10.7%). The drug resistance rates of these MTB strains against 9 anti-tuberculous drugs exhibited obvious diversity. Isoniazid (INH) (20.4%) showed the highest drug-resistance rate while capreomycin (CPM) (2.2%) is the lowest. The drug resistance rates of INH, levofloxacin (LFX), CPM and p-aminosalicylic acid (PAS) showed a significant increasing trend during 2017-2020 (P＜0.05). The overall proportions of mono-resistant tuberculosis (MR-TB), poly-drug resistant tuberculosis (PDR-TB), multi-drug resistant tuberculosis (MDR-TB) and extensively-drug resistant tuberculosis (XDR-TB) isolates were 9.2%, 6.5%, 12.7%, and 2.2%, respectively. The proportions of MR-TB and PDR-TB significantly decreased in last four years (P＜0.05) , while the proportions of MDR-TB and XDR-TB significantly increased (P＜0.05). It's also worth noting that all of NTM strains showed drug resistance to 9 anti-tuberculous drugs. Conclusions?MTB was the major pathogen of Mycobacterium infection in Nanjing area. The MDR-TB and XDR-TB showed a significant increasing trend. MIN, MAB and MAV were the main strains of NTM, which were generally resistant to common anti-tuberculous drugs. We should further strengthen the isolation and identification of Mycobacterium in clinic and closely monitor the drug resistance of related strains in the long-term, which could provide theoretical basis for disease control and clinical treatment. |
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