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某三甲医院肺外非结核分枝杆菌感染的微生物学特征分析

Microbiological Characteristics of Extrapulmonary Nontuberculous Mycobacterial Infections in a Tertiary Hospital

    摘要
  • 摘要:
    目的 本研究旨在分析某三甲医院肺外非结核分枝杆菌（extrapulmonary nontuberculous mycobacterial, ENTM）感染的微生物学特征，为ENTM感染的临床诊疗提供数据支撑。
    方法 回顾性分析四川大学华西医院2020–2023年分枝杆菌培养结果，共纳入ENTM感染确诊病例68例，所有纳入病例均符合《非结核分枝杆菌病诊断与治疗指南（2020年版）》中肺外感染的诊断标准。分析纳入病例的人口学特征、菌种分布特征及药敏试验结果。采用质谱技术进行微生物菌种鉴定，采用微量肉汤稀释法进行药敏试验。
    结果 68例ENTM感染病例中，男女比例为1∶1.2，40～59岁为主要感染人群，感染部位以皮肤软组织最常见。标本主要来源为脓液（33.8%，23例），其次为病理组织（26.5%，18例）；确诊患者主要来源于感染科（29.4%，20例）。68例ENTM中，快速生长型分枝杆菌（rapid-growing mycobacterial, RGM）占32.4%（22例），最常见菌种为脓肿分枝杆菌；缓慢生长型分枝杆菌（slowly-growing mycobacterial, SGM）占比67.6%（46例），最常见菌种为胞内分枝杆菌和海分枝杆菌。RGM对利福平、利福布汀等抗生素具有较高的最低抑菌浓度（minimal inhibitory concentration, MIC），对克拉霉素、阿米卡星具有较低MIC值；SGM对大多数抗生素均具有较低的MIC值。
    结论 本研究中ENTM感染最常累及皮肤软组织，病原菌以SGM为主，其中胞内分枝杆菌占据主导地位。RGM对克拉霉素和阿米卡星敏感，可为经验性抗感染治疗提供参考依据；SGM虽对多数受试药物表现出较低的MIC，但临床治疗时仍需采用联合用药方案，并充分评估治疗失败的风险。

     

    Abstract:
    Objective To analyze the microbiological characteristics of extrapulmonary nontuberculous mycobacterial (ENTM) infections in a tertiary hospital and to provide data to support clinical diagnosis and treatment of ENTM infections.
    Methods A retrospective analysis was conducted on mycobacterial culture results from West China Hospital, Sichuan University from 2020 to 2023. A total of 68 confirmed cases of ENTM infection were enrolled, with all of which meeting the diagnostic criteria for extrapulmonary infection outlined in the Guidelines for the Diagnosis and Treatment of Nontuberculous Mycobacterial Disease (2020). Demographic data, strain distribution, and drug susceptibility test results were analyzed. Microbial species identification was performed using mass spectrometry, and drug susceptibility was assessed using the microbroth microdilution method.
    Results Among the 68 ENTM cases, the male-to-female ratio was 1 to 1.2, with individuals aged 40-59 years being the main affected group population. The most common sites of infection were the skin and soft tissues. The primary specimen source was pus (33.8%, 23 cases), followed by pathological tissues (26.5%, 18 cases). The Department of Infectious Diseases was the main source of confirmed cases (29.4%, 20 cases). Among the 68 EMTM cases, rapid-growing mycobacteria (RGM) accounted for 32.4% (22 cases), with Mycobacterium abscessus being the predominant species, while slowly-growing mycobacteria (SGM) accounted for 67.6% (46 cases), with Mycobacterium intracellulare and Mycobacterium marinum being the predominant species. RRGM exhibited higher minimum inhibitory concentration (MICs) for rifampicin and rifabutin but lower MICs for clarithromycin and amikacin. In contrast, SGM demonstrated low MICs for most antibiotics tested.
    Conclusion In this study, ENTM infections most commonly involve the skin and soft tissues, with SGM being the predominant pathogens and Mycobacterium intracellulare being the dominant species. RGM shows susceptibility to clarithromycin and amikacin, which provides a basis for empirical anti-infective therapy. Although SGM exhibits low MICs to most tested antimicrobial agents, combination regimens remain necessary in clinical practice, and the risk of treatment failure should be thoroughly evaluated.

     

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