重庆市2016-2017年非结核分枝杆菌流行状况分析
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摘要
目的探讨分析重庆市非结核分枝杆菌(NTM)的流行趋势和耐药情况。方法对2016年1月至2017年12月该中心结核实验室分离培养的NTM相关结果进行统计分析。结果 2016-2017年分离培养的4 965例分枝杆菌中结核分枝杆菌4 682例,NTM 283例,NTM分离率为5.70%。痰和纤支镜灌洗液中分离到的NTM最多。男性NTM感染者多于女性,比例为1.77∶1,发病年龄主要集中于20～60岁。耐药比例最高者为异烟肼、力克肺疾和对氨基水杨酸,高耐药比例均超过90.00%。最敏感的药物为克拉霉素,敏感率超过70.00%。乙胺丁醇、莫西沙星和利福布丁的高耐药比例呈现下降趋势,而利奈唑胺的敏感比例明显下降,而高耐药比例则明显上升。结论重庆市NTM分离率低于全国平均水平,感染人群多为青壮年,且耐药率高。应加强实验室分子诊断和药敏试验的能力和水平,更好地控制结核与NTM感染。
Objective To investigate the prevalence and drug-resistant pattern of nontuberculous mycobacteria(NTM)in Chongqing.Methods Relevant laboratory data during 2016-2017 on NTM culture,identification and drug-susceptibility test were analyzed statistically.Results A total of 4 965 positive cultures were obtained during 2016-2017,among which 4 682 strains were mycobacterium tuberculosis(MTB)and 283 strains(5.70%)were NTM.Most NTM were isolated from sputum and bronchoscopy lavage fluid.The male infections were more than the temale,with the gender ratio of male to female on NTM infection was 1.77∶1,the age concentrated mainly on 20 to 60 years.The NTM were most resistant to isoniazid,dipasic and paminosalicylic acid,with drug-resistant percentage more than 90.00%.Clarithromycin was the most susceptible drug to NTM with the sensitive rate more than 70.00%.The high drug-resistant ratio of ethambutol,moxifloxcin and rifabutin were declined.The susceptible ratio of linezolid was dropped obviously,but drug-resistant ratio was increased.Conclusion The prevalence of NTM in Chongqing is lower than the average level of whole nation,the most NTM patients in Chongqing are young adults with high drug-resistant rate.It is necessary to develop the ability of laboratory molecular diagnosis and drug-susceptible test in order to control TB and NTM better.
Objective To investigate the prevalence and drug-resistant pattern of nontuberculous mycobacteria(NTM)in Chongqing.Methods Relevant laboratory data during 2016-2017 on NTM culture,identification and drug-susceptibility test were analyzed statistically.Results A total of 4 965 positive cultures were obtained during 2016-2017,among which 4 682 strains were mycobacterium tuberculosis(MTB)and 283 strains(5.70%)were NTM.Most NTM were isolated from sputum and bronchoscopy lavage fluid.The male infections were more than the temale,with the gender ratio of male to female on NTM infection was 1.77∶1,the age concentrated mainly on 20 to 60 years.The NTM were most resistant to isoniazid,dipasic and paminosalicylic acid,with drug-resistant percentage more than 90.00%.Clarithromycin was the most susceptible drug to NTM with the sensitive rate more than 70.00%.The high drug-resistant ratio of ethambutol,moxifloxcin and rifabutin were declined.The susceptible ratio of linezolid was dropped obviously,but drug-resistant ratio was increased.Conclusion The prevalence of NTM in Chongqing is lower than the average level of whole nation,the most NTM patients in Chongqing are young adults with high drug-resistant rate.It is necessary to develop the ability of laboratory molecular diagnosis and drug-susceptible test in order to control TB and NTM better.
引文
[1]中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.非结核分枝杆菌病诊断与治疗专家共识[J].中华结核和呼吸杂志,2012,35(8):572-580.
[2] FALKINHAM J O 3RD.Nontuberculous mycobacteria in the environment[J].Clin Chest Med,2002,23(3):529-551.
[3] ABOAGYE S Y,DANSO E,AMPAH K A,et al.Isolation of nontuberculous mycobacteria from the environment of ghanian communities where buruli ulcer is endemic[J].Appl Environ Microbiol,2016,82(14):4320-4329.
[4]马屿,王敬.重视非结核分枝杆菌肺病与肺结核的鉴别[J].临床肺科杂志,2010,15(3):301-302.
[5] DALEY C L,GRIFFITH D E.Pulmonary non-tuberculous mycobacterial infections[J].Int J Tuberc Lung Dis,2010,14(6):665-671.
[6]王生伟,施旭东.结核分枝杆菌和非结核分枝杆菌混合感染的病例分析[J].临床肺科杂志,2014,19(1):172-173.
[7] MAIGA M,SIDDIQUI S,DIALLO S,et al.Failure to recognize nontuberculous mycobacteria leads to misdiagnosis of chronic pulmonary tuberculosis[J].PloS One,2012,7(5):e36902.
[8] THOMSON R M.Changing epidemiology of pulmonary nontuberculous mycobacteria infections[J].Merg Infect Dis,2010,16(10):1576-83.
[9] PREVOTS D R,MARRAS T K.Epidemiology of human pulmonary infection with nontuberculous mycobacteria:a review[J].Clin Chest Med,2015,36(1):13-34.
[10]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国文化教育出版社,2006.
[11]WHO.Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis[M].Geneva:World Health Organization,2014.
[12]JING H,WANG H,WANG Y,et al.Prevalence of nontuberculous mycobacteria infection,China,2004-2009[J].Emerg Infect Dis,2012,18(3):527-528.
[13]CHEN C Y,CHEN H Y,CHOU C H,et al.Pulmonary infection caused by nontuberculous mycobacteria in a medical center in Taiwan,2005-2008[J].Diagn Microbiol Infect Dis,2012,72(1):47-51.
[14]VINNARD C,LONGWORTH S,MEZOCHOW A,et al.Deaths related to nontuberculous mycobacterial infections in the united states,1999-2014[J].Ann Am Thorac Soc,2016,13(11):1951-1955.
[15]RINGSHAUSEN F C,WAGNER D,DE ROUX A,et al.Prevalence of nontuberculous mycobacterial pulmonary disease,Germany,2009-2014[J].Emerg Infect Dis,2016,22(6):1102-1105.
[16]MARRAS T K,MENDELSON D,MARCHAND-AUSTIN A,et al.Pulmonary nontuberculous mycobacterial disease,Ontario,Canada,1998-2010[J].Emerg Infect Dis,2013,19(11):1889-1891.
[17]王宇.全国第五次结核病流行病学抽样调查资料汇编[M].北京:军事医学科学出版社,2011.
[18]余雅,刘英,胡代玉,等.2009-2013年重庆市肺结核疫情特征分析[J].中国防痨杂志,2014,36(12):1036-1042.
[19]吕圣秀.非结核分枝杆菌肺病24例的CT表现[J].临床肺科杂志,2008,13(5):631-632.
[20]周汛,何晓琴,李惠.非结核分枝杆菌感染致皮肤慢性溃疡[J].临床皮肤科杂志,2007,36(8):508-510.
[21]周刚,王易伟,李同心,等.三种方法用于耐多药肺结核患者菌种初步鉴定的比较分析[J].临床肺科杂志,2016,21(9):1725-1728.
[22]曹培明,刘奉凤,李桓.58例非结核分枝杆菌的临床分析[J].重庆医学,2014,43(7):854-856.
[23]黄明忠,蒋克珉.非结核分支杆菌肺病48例诊治体会[J].重庆医学,2002,31(8):758-759.
[24]张春智,娄乐山,钟敏,等.非结核分支杆菌肺病8例误诊分析[J].临床肺科杂志,2000,5(4):306-307.
[25]李昕洁,谭守勇,黄业伦,等.812株非结核分枝杆菌临床分离株流行病学特征分析[J].中国防痨杂志,2010,32(12):811-814.
[26]李定越,杨筠,刘兴菊,等.四川省非结核分枝杆菌耐药分析[J].寄生虫病与感染性疾病,2012,10(3):159-161.
[27]齐志强.湖南地区非结核分枝杆菌临床分离株菌种的鉴定及耐药性分析[D].长沙:中南大学,2014.
[28]杨成凤,叶建君,童叶青,等.湖北省五个耐药肺结核诊治试点地区非结核分枝杆菌流行特征分析[J].中国防痨杂志,2016,38(8):659-664.
[29]周爱萍,贺拥军,孙亚楠,等.西安市非结核分枝杆菌感染现状调查分析[J].中国人兽共患病学报,2015,31(12):1196-1199.
[30]周伟杰,王文,刘同杰.5937例结核病患者非结核分枝杆菌感染及其对抗结核药物耐药情况分析[J].山东医药,2016,56(12):72-73.
[31]中华医学会结核病学分会,非结核分枝杆菌病实验室诊断专家共识编写组.非结核分枝杆菌病实验室诊断专家共识[J].中华结核和呼吸杂志,2016,39(6):438-443.
[32]胡洁,徐文贤,宋秀兰,等.嘉兴地区2013-2014年非结核分枝杆菌流行状况分析[J].中国预防医学杂志,2015,16(9):731-732.
[33]高爱霞,黄秋生,华少鹏,等.无锡地区非结核分枝杆菌肺病临床特征及耐药特点分析[J].中国卫生检验杂志,2015,25(12):2033-2035.
[34]崔振玲,陆俊梅,杨华,等.复治肺结核患者对氟喹诺酮类药物交叉耐药情况的体外研究[J].中国防痨杂志,2017,39(1):51-56.
[2] FALKINHAM J O 3RD.Nontuberculous mycobacteria in the environment[J].Clin Chest Med,2002,23(3):529-551.
[3] ABOAGYE S Y,DANSO E,AMPAH K A,et al.Isolation of nontuberculous mycobacteria from the environment of ghanian communities where buruli ulcer is endemic[J].Appl Environ Microbiol,2016,82(14):4320-4329.
[4]马屿,王敬.重视非结核分枝杆菌肺病与肺结核的鉴别[J].临床肺科杂志,2010,15(3):301-302.
[5] DALEY C L,GRIFFITH D E.Pulmonary non-tuberculous mycobacterial infections[J].Int J Tuberc Lung Dis,2010,14(6):665-671.
[6]王生伟,施旭东.结核分枝杆菌和非结核分枝杆菌混合感染的病例分析[J].临床肺科杂志,2014,19(1):172-173.
[7] MAIGA M,SIDDIQUI S,DIALLO S,et al.Failure to recognize nontuberculous mycobacteria leads to misdiagnosis of chronic pulmonary tuberculosis[J].PloS One,2012,7(5):e36902.
[8] THOMSON R M.Changing epidemiology of pulmonary nontuberculous mycobacteria infections[J].Merg Infect Dis,2010,16(10):1576-83.
[9] PREVOTS D R,MARRAS T K.Epidemiology of human pulmonary infection with nontuberculous mycobacteria:a review[J].Clin Chest Med,2015,36(1):13-34.
[10]中国防痨协会基础专业委员会.结核病诊断实验室检验规程[M].北京:中国文化教育出版社,2006.
[11]WHO.Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis[M].Geneva:World Health Organization,2014.
[12]JING H,WANG H,WANG Y,et al.Prevalence of nontuberculous mycobacteria infection,China,2004-2009[J].Emerg Infect Dis,2012,18(3):527-528.
[13]CHEN C Y,CHEN H Y,CHOU C H,et al.Pulmonary infection caused by nontuberculous mycobacteria in a medical center in Taiwan,2005-2008[J].Diagn Microbiol Infect Dis,2012,72(1):47-51.
[14]VINNARD C,LONGWORTH S,MEZOCHOW A,et al.Deaths related to nontuberculous mycobacterial infections in the united states,1999-2014[J].Ann Am Thorac Soc,2016,13(11):1951-1955.
[15]RINGSHAUSEN F C,WAGNER D,DE ROUX A,et al.Prevalence of nontuberculous mycobacterial pulmonary disease,Germany,2009-2014[J].Emerg Infect Dis,2016,22(6):1102-1105.
[16]MARRAS T K,MENDELSON D,MARCHAND-AUSTIN A,et al.Pulmonary nontuberculous mycobacterial disease,Ontario,Canada,1998-2010[J].Emerg Infect Dis,2013,19(11):1889-1891.
[17]王宇.全国第五次结核病流行病学抽样调查资料汇编[M].北京:军事医学科学出版社,2011.
[18]余雅,刘英,胡代玉,等.2009-2013年重庆市肺结核疫情特征分析[J].中国防痨杂志,2014,36(12):1036-1042.
[19]吕圣秀.非结核分枝杆菌肺病24例的CT表现[J].临床肺科杂志,2008,13(5):631-632.
[20]周汛,何晓琴,李惠.非结核分枝杆菌感染致皮肤慢性溃疡[J].临床皮肤科杂志,2007,36(8):508-510.
[21]周刚,王易伟,李同心,等.三种方法用于耐多药肺结核患者菌种初步鉴定的比较分析[J].临床肺科杂志,2016,21(9):1725-1728.
[22]曹培明,刘奉凤,李桓.58例非结核分枝杆菌的临床分析[J].重庆医学,2014,43(7):854-856.
[23]黄明忠,蒋克珉.非结核分支杆菌肺病48例诊治体会[J].重庆医学,2002,31(8):758-759.
[24]张春智,娄乐山,钟敏,等.非结核分支杆菌肺病8例误诊分析[J].临床肺科杂志,2000,5(4):306-307.
[25]李昕洁,谭守勇,黄业伦,等.812株非结核分枝杆菌临床分离株流行病学特征分析[J].中国防痨杂志,2010,32(12):811-814.
[26]李定越,杨筠,刘兴菊,等.四川省非结核分枝杆菌耐药分析[J].寄生虫病与感染性疾病,2012,10(3):159-161.
[27]齐志强.湖南地区非结核分枝杆菌临床分离株菌种的鉴定及耐药性分析[D].长沙:中南大学,2014.
[28]杨成凤,叶建君,童叶青,等.湖北省五个耐药肺结核诊治试点地区非结核分枝杆菌流行特征分析[J].中国防痨杂志,2016,38(8):659-664.
[29]周爱萍,贺拥军,孙亚楠,等.西安市非结核分枝杆菌感染现状调查分析[J].中国人兽共患病学报,2015,31(12):1196-1199.
[30]周伟杰,王文,刘同杰.5937例结核病患者非结核分枝杆菌感染及其对抗结核药物耐药情况分析[J].山东医药,2016,56(12):72-73.
[31]中华医学会结核病学分会,非结核分枝杆菌病实验室诊断专家共识编写组.非结核分枝杆菌病实验室诊断专家共识[J].中华结核和呼吸杂志,2016,39(6):438-443.
[32]胡洁,徐文贤,宋秀兰,等.嘉兴地区2013-2014年非结核分枝杆菌流行状况分析[J].中国预防医学杂志,2015,16(9):731-732.
[33]高爱霞,黄秋生,华少鹏,等.无锡地区非结核分枝杆菌肺病临床特征及耐药特点分析[J].中国卫生检验杂志,2015,25(12):2033-2035.
[34]崔振玲,陆俊梅,杨华,等.复治肺结核患者对氟喹诺酮类药物交叉耐药情况的体外研究[J].中国防痨杂志,2017,39(1):51-56.