湖南省某专科医院非结核分枝杆菌临床分离株菌种鉴定及药敏结果

 目的 探讨非结核分枝杆菌肺病（NTMPD）菌种分布及耐药性，为其临床诊治提供依据。方法 收集2017—2019年湖南省某胸科医院BACTEC MGIT 960系统培养阳性的临床分离菌株，经MPB64检测以及PNB、TCH培养基生长试验分离出非结核分枝杆菌（NTM），应用16Sr RNA、Hsp65、ITS基因测序法将NTM鉴定至种，采用最低抑菌浓度（MIC）法检测其中脓肿分枝杆菌对10种抗菌药物的耐药性。结果 10 443份MGIT 960报告阳性的菌株中，共检出NTM 1 227株，检出率为11.7%。经菌种鉴定，居前4位者依次为胞内分枝杆菌（27.8%）、脓肿分枝杆菌（25.3%）、戈登分枝杆菌（16.5%）、鸟分枝杆菌（16.1%）。脓肿分枝杆菌对阿米卡星、克拉霉素和利奈唑胺的敏感性较高，敏感率分别是94.6%、87.5%、82.1%；对其他药物的敏感率均低于50%。结论 湖南省NTM流行的菌种以脓肿分枝杆菌和胞内分枝杆菌为主，阿米卡星和克拉霉素可作为该省临床治疗脓肿分枝杆菌感染患者的优选抗菌药物。

Species identification and antimicrobial susceptibility testing result of clinically isolated non-tuberculous mycobacteria in a specialized hospital in Hunan Province

Objective To investigate species distribution and antimicrobial resistance of non-tuberculous mycobacterial pulmonary disease (NTMPD), and provide basis for clinical diagnosis and treatment. Methods Positive clinical isolates cultured with BACTEC MGIT 960 system in a chest hospital in Hunan Province from 2017 to 2019 were collected, non-tuberculous mycobacteria (NTM) was isolated by MPB64 detection and PNB/TCH medium growth testing, NTM species were identified by 16Sr RNA, Hsp65 and ITS gene sequencing, resistance of Mycobacterium abscessus to 10 kinds of antimicrobial agents was detected with minimal inhibitory concentration (MIC) method. Results Among 10 443 positive strains reported by MGIT 960, 1 227 NTM strains were isolated, isolation rate was 11.7%. The top 4 strains were Mycobacterium intracellulare (27.8%), Mycobacterium abscessus (25.3%), Mycobacterium gordonae (16.5%) and Mycobacterium avium (16.1%). Susceptibility rates of Mycobacterium abscessus to amikacin, clarithromycin and linezolid were high, which were 94.6%, 87.5% and 82.1% respectively, while susceptibility rates to other antimicrobial agents were all lower than 50%. Conclusion Mycobacterium abscessus and Mycobacterium intracellular are the most prevalent strains of NTM in Hunan Province, amikacin and clarithromycin can be used as the preferred antimicriobial agents for clinical treatment of patients with Mycobacte-rium abscessus infection in Hunan Province.