Abstract：Objective To learn the prevalence and drug resistance of nontuberculous mycobacteria ( NTM ) in Zhejiang Province, so as to provide evidence for NTM prevention and control. Methods A total of 2 878 clinical mycobacterium isolates in Zhejiang Province were collected from the drug resistance surveillance in 2008-2009, 2013-2014 and 2018-2019, PNB/TCH growth tests were used to preliminarily identify the NTM in these mycobacterium-positive isolates. 16SrRNA, rpoB, ITS and hsp65 gene sequencing analysis were used to confirm strains initially identified as NTM. Proportional method was applied to detect drug susceptibility of NTM isolates. Results Finally, 135 strains were confirmed as NTM and the isolation rate was 4.69%. The isolation rates of NTM in 2008-2009, 2013-2014 and 2018-2019 were 1.85%, 4.56% and 7.84%, respectively, with an increasing trend ( P<0.05 ). Thirteen species were identified and the top two species were M. intracellulare ( 82, 60.74% ) and M. kansassi ( 18, 13.33% ). The NTM isolates showed the highest drug resistance rate to isoniazid ( 97.78% ), followed by p-aminosalicylic acid ( 94.87% ) and streptomycin ( 94.81% ). Conclusions The isolation rates of NTM showed an upward trend in the drug resistance surveillance in 2008-2019,2013-2014 and 2018-2019 in Zhejiang Province. M. intracellulare and M. kansassi were the main strains isolated. The NTM isolates showed high resistance against both first and second-line antituberculosis drugs.
[1] 唐神结,沙巍,肖和平,等.非结核分枝杆菌病的研究进展[J].中华结核和呼吸杂志,2012,35(7):527-531. [2] AKSAMIT T R.Mycobacterium avium complex pulmonary disease in patients with pre-existing lung disease[J].Clin Chest Med,2002,23(3):643-653. [3] VAN INGEN J,KUIJPER E J.Drug susceptibility testing of nontuberculous mycobacteria[J].Future Microbiol,2014,9(9):1095-1110. [4] ZWEIJPFENNING S M H,INGEN J V,HOEFSLOOT W.Geographic distribution of nontuberculous mycobacteria isolated from clinical specimens:a systematic review[J].Semin Respir Crit Care Med,2018,39(3):336-342. [5] BRODE S K,DALEY C L,MARRAS T K.The epidemiologic relationship between tuberculosis and non-tuberculous mycobacterial disease:a systematic review[J].Int J Tuberc Lung Dis,2014,18(11):1370-1377. [6] 刘东鑫,郑惠文,贺文从,等.广州市非结核分枝杆菌临床分离株菌种鉴定及药物敏感性试验结果分析[J].中国防痨杂志,2019,41(5):534-540. [7] 赵雁林,逄宇.结核病实验室检验规程[M].北京:人民卫生出版社,2015:45-65. [8] JEON D.Infection source and epidemiology of nontuberculous mycobacterial lung disease[J].Tuberc Respir Dis,2019,82(2):94-101. [9] 张智健. 脓肿分枝杆菌复合群的药物敏感性分析及其对克拉霉素的耐药机制研究[D].北京:中国人民解放军医学院,2015:54-57. [10] 全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508. [11] SHAO Y,CHEN C,SONG H,et al.The epidemiology and geographic distribution of nontuberculous mycobacteria clinical isolates from sputum samples in the eastern region of China[J/OL].PLoS Negl Trop Dis,2015(2015-03-16)[2020-09-27].https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003623. [12] 陈涛,许琳,杨慧娟,等.云南省非结核分枝杆菌流行状况及病原谱分析[J].中国热带医学,2018,18(9):863-865. [13] 洪创跃,李金莉,赵广录,等.2013—2017年深圳市非结核分枝杆菌流行状况分析[J].中国防痨杂志,2019,41(5):529-533. [14] WHILEY H,KEEGAN A,GIGLIO S,et al.Mycobacterium avium complex-the role of potable water in disease transmission[J].J Appl Microbiol.2012,113(2):223-232. [15] LI Y,PANG Y,TONG X,et al.Mycobacterium kansasii subtype I is associated with clarithromycin resistance in China[J/OL].Front Microbiol,2016(2016-12-26)[2020-09-27].https://www.frontiersin.org/articles/10.3389/fmicb.2016.02097/full. [16] GROTTOLA A,ROVERSI P,FABIO A,et al.Pulmonary disease caused by Mycobacterium marseillense,Italy[J].Emerg Infect Dis,2014,20(10):1769-1770. [17] AZZALI A,MONTAGNANI C,SIMONETTI M T,et al.First case of Mycobacterium marseillense lymphadenitis in a child[J/OL].Ital J Pediatr,2017(2017-10-10)[2020-09-27].https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0413-5. [18] SNCHEZ-C RDENAS C D,ZAMBRANO M T,MART NEZ-CHAVARRIA L C,et al.Cutaneous infection due to Mycobacterium marseillense acquired following acupuncture[J].Acupunct Med,2020,38(3):205-206. [19] XIE B,CHEN Y,WANG J,et al.Mycobacterium marseillense infection in human skin,China,2018[J].Emerg Infect Dis,2019,25(10):1991-1993. [20] 郭倩,朱召芹,钱雪琴,等.上海地区艾滋病患者合并非结核分枝杆菌感染菌种分布[J].中华传染病杂志,2019,37(2):93-96. [21] 余斐,陈晓,嵇仲康,等.杭州地区2009—2014年非结核分枝杆菌流行状况分析[J].中国微生态学杂志,2016,28(7):808-815. [22] 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. [23] 何贵清,徐克,单志力,等.2014至2016年温州地区呼吸道非结核分枝杆菌的流行状况分析[J].中华临床感染病杂志,2017,10(4):262-267. [24] TAN Y,SU B,SHU W,et al.Epidemiology of pulmonary disease due to nontuberculous mycobacteria in Southern China,2013-2016[J/OL].BMC Pulm Med,2018(2018-11-09)[2020-09-27].https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-018-0728-z. [25] 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. [26] MOUGARI F,LOISEAU J,VEZIRIS N,et al.Evaluation of the new Genotype NTM-DR kit for the molecular detection of antimicrobial resistance in non-tuberculous mycobacteria[J].J Antimicrob Chemother,2017,72(6):1669-1677.
