2013-2018年河南省耐药监测点非结核分枝杆菌流行特征分析

目的 了解2013-2018年河南省南阳市辖区、中牟县、新密市、嵩县和扶沟县5个耐药监测点非结核分枝杆菌(NTM)感染情况、主要种类及其耐药性。方法 采用传统PNB/TCH生长试验对分枝杆菌培养阳性标本初步鉴定,用探针熔解曲线法和PCR产物测序鉴定NTM菌种,采用比例法检测分离菌株的敏感性。结果 1 781例分枝杆菌阳性培养物标本中,67株PNB/TCH生长试验结果阳性。67例标本中,2株为结核分枝杆菌,65例NTM中,胞内分枝杆菌49例(75.4%),其它16例占比为24.6%。1 781例病人中,男性感染率为3.8%(53/1 388),女性感染率为3.1%(12/393),差异无统计学意义(χ²=0.510,P>0.05)。50岁以下患者感染率为2.3%(20/840),50岁以上的患者感染率为4.8%(45/941),差异有统计学意义(χ²=7.303,P<0.01)。初治病人感染率为2.2%(24/1 097),复治病人感染率为6.0%(41/684),差异有统计学意义(χ²=17.359,P<0.01)。65例NTM对INH的耐药率为100%,对RFP、SM、OFX、CPM、PAS的耐药率超过了80%,耐多药率达到95.4%,广泛耐药率达到89.2%。 胞内分枝杆菌是河南耐药监测地区近年优势流行的NTM菌种,NTM感染者中男性多于女性,中老年人易感,复治患者感染较多,NTM临床菌株对常用抗结核药物普遍耐药。

Analysis of characteristics of nontuberculous mycobacterial infections at drug resistance monitoring points in Henan Province,2013-2018

This study aimed to determine the infection rate,main species and drug resistance of nontuberculous mycobacterium(NTM)in five drug resistance monitoring locations in Henan Province,2013-2018.A total of 1781 mycobacterium positive cultures were initially identified by the traditional PNB/TCH growth test,then by the melting curve method and PCR sequencing.The drug susceptibility to INH,RFP,EMB,SM,KM,OFX,CPM,PTO and PAS was tested with the proportional method.Among the 1781 samples,67 were positive by PNB/TCH.Melting curve analysis and PCR sequencing revealed that two were M.tuberculosis.Of the 65 NTM cases,M.intracellulare accounted for 75.4%(49/65),and M.kansasii accounted for 7.7%(5/65).A small number of cases were due to M.abscess(n=3,4.6%),M.avium(2,3.1%)and M.septicum(1,1.5%).M.tuberculosis and M.intracellulare co-infection accounted for 7.7%(5/65).Of the 1781 patients,the infection rate was 3.8%(53/1388)in men and 3.1%(12/393)in women.There was no statistical difference(χ²=0.510,P=0.475).The infection rate in patients younger than 50 years old was 2.3%(20/840),and that in patients over 50 years old was 4.8%(45/941).The difference was statistically significant(χ²=7.303,P<0.01).The infection rate was 2.2%(24/1097)in initially treated patients and 6.0%(41/684)in retreated patients;the difference was statistically significant(χ²=17.359,P<0.01).The drug resistance rate was 100%to INH and was above 80%to RFP,SM,OFX,CPM and PAS.The multi-drug resistance rate for NTM was 95.4%,and the rate of extensive drug resistance was 89.2%.Together,the results indicated that M.intracellulare was the dominant NTM strain in Henan’s drug resistance monitoring areas.The ratio of men infected with NTM was higher than that of women.Older and retreated patients were more susceptible to NTM.Finally,the NTM strains were generally resistant to common anti-tuberculosis drugs.