2018—2020年平顶山地区非结核分枝杆菌菌种鉴定及耐药性分析

本文旨在观察2018—2020年河南省平顶山地区非结核分枝杆菌(nontuberculous mycobacteria，NTM)的菌种分布及耐药情况。收集2018年1月—2020年12月平顶山市传染病医院分离到的326株NTM，采用DNA微阵列芯片鉴定菌种，改良罗氏培养基比例法进行药敏试验。结果显示，从61～80岁患者中分离的NTM菌株最多，其次是41～60岁患者。共鉴定出8个NTM菌种，分别为胞内分枝杆菌(35.28%)、龟/脓肿分枝杆菌(24.85%)、鸟分枝杆菌(18.40%)、偶然分枝杆菌(5.21%)、戈登分枝杆菌(1.23%)、堪萨斯分枝杆菌(12.58%)、浅黄分枝杆菌(1.53%)、瘰疬分枝杆菌(0.92%)。NTM对异烟肼的耐药率最高，为97.85%。除戈登分枝杆菌外，其他NTM菌种对异烟肼的耐药率均＞94%；胞内分枝杆菌对丙硫异烟胺的耐药率(8.70%)相对较低，鸟分枝杆菌对丙硫异烟胺的耐药率为10.00%；龟/脓肿分枝杆菌对异烟肼、利福平、链霉素、乙胺丁醇、阿米卡星的耐药率均＞95%；偶然分枝杆菌对左氧氟沙星的耐药率为35.29%，堪萨斯分枝杆菌对左氧氟沙星的耐药率最低(7.32%)；戈登分枝杆菌对异烟肼、乙胺丁醇、链霉素、对氨基水杨酸的耐药率均≥50%；浅黄分枝杆菌对乙胺丁醇、左氧氟沙星、阿米卡星、卡那霉素的耐药率均＜50%；瘰疬分枝杆菌对阿米卡星和丙硫异烟胺的耐药率为0。结果提示，2018—2020年河南省平顶山地区鉴定出的8个NTM菌种中，胞内分枝杆菌占比最高，不同菌种对不同抗结核药物的耐药性差异较大，因此菌种鉴定对临床治疗有重要意义。

Identification and drug resistance analysis of nontuberculous mycobacteria in Pingdingshan region from 2018 to 2020

The present paper aims to analyze the species distribution and drug resistance of nontuberculous mycobacteria (NTM) in Pingdingshan region of Henan Province from 2018 to 2020. A total of 326 NTM strains isolated from Pingdingshan Infectious Disease Hospital from January 2018 to December 2020 were collected. NTM strains were identified by DNA microarray chip, and the modified Lowenstein-Jensen medium was used for drug sensitivity test. The results showed that most of the NTM strains were isolated from the patients aged from 61 to 80 years, followed by the age group of 41 to 60 years. Eight NTM species were identified, namely Mycobacterium intracellulare (35.28%), Mycobacterium chelonae/Mycobacterium abscessus (24.85%), Mycobacterium avium (18.40%), Mycobacterium fortuitum (5.21%), Mycobacterium gordonae (1.23%), Mycobacterium kansasii (12.58%), Mycobacterium gilvum (1.53%), and Mycobacterium scrofulaceum (0.92%). These NTM strains had the highest resistance rate to isoniazid, as high as 97.85%. Except for Mycobacterium gordonae, the resistance rate of NTM strains to isoniazid was ＞94%. Mycobacterium intracellulare had a relatively low resistance rate to prothionamide (8.70%), and the resistance rate of Mycobacterium avium to prothionamide was 10.00%. The resistance rates of Mycobacterium chelonae/Mycobacterium abscessus to isoniazid, rifampicin, streptomycin, ethambutol, and amikacin were ＞95%. Mycobacterium fortuitum had a resistance rate of 35.29% to levofloxacin, and the resistance rate of Mycobacterium kansasii to levofloxacin was 7.32%. The resistance rates of Mycobacterium gordonae to isoniazid, ethambutol, streptomycin and p-aminosalicylic acid were ≥50%. Mycobacterium gilvum had a resistance rate of ＜50% to ethambutol, levofloxacin, amikacin, and kanamycin. Mycobacterium scrofulaceum was not resistant to amikacin and prothiazamide. In conclusion, eight NTM species were found in Pingdingshan region from 2018 to 2020, among which Mycobacterium intracellular accounted for a largest proportion. There are great differences in drug resistance among different NTM species, and the identification of NTM species is of great significance for the treatment of patients.