Clinical characteristics and drug resistance of 84 patients with non-tuberculous mycobacterium pulmonary disease

doi:10.3969/j.issn.2096-8493.20210054

Abstract

Abstract:

Objective To analyze the clinical characteristics, strain distribution and drug resistance to common anti-tuberculosis drugs in patients with non-tuberculous mycobacteria (NTM) lung disease. Methods The clinical data of 84 patients with NTM lung disease (NTM group) and 84 patients with pulmonary tuberculosis (pulmonary tuberculosis group) diagnosed in Suzhou Fifth People’s Hospital from January 2016 to January 2021 were collected by retrospective analysis according to the inclusion criteria, and the differences between the two groups in previous medical history, clinical symptoms and imaging manifestations at the initial stage of admission were analyzed. The identification results of NTM isolates and the drug resistance of each strain to isoniazid, streptomycin, p-aminosalicylic acid, amikacin, levofloxacin, rifampicin, ethambutol and isonicotinamide were recorded. Results The patients in NTM group had chronic respiratory diseases (22.6% (19/84)), fever (27.4% (23/84)), cough (95.2% (80/84)), hemoptysis (29.8% (25/84)), chest tightness (40.5% (34/84)), with pulmonary cavity (38.1% (32/84)) and bronchiectasis (45.2% (38/84)) and negative γ-interferon release test (77.4% (65/84)) were significantly higher than those of tuberculosis group (2.4% (2/84), 3.6% (3/84), 57.1% (48/84), 9.5% (8/84), 15.5% (13/84), 21.4% (18/84), 7.1% (6/84), 2.4% (2/84)), the differences were statistically significant (χ²=15.728,P<0.001;χ²=18.202,P<0.001;χ²=38.403,P<0.001;χ²=10.898,P=0.001;χ²=13.028,P<0.001;χ²=5.581,P=0.018;χ²=31.531,P<0.001;χ²=98.536,P<0.001).The top three strains of 84 NTM isolates were Mycobacterium intracellular (58 strains, 69.0%), Mycobacterium Kansas (15 strains, 17.9%) and M.chelonicus/abscess (6 strains, 7.1%). According to the results of drug sensitivity test, in this study, the resistance rates of 84 patients with NTM to 8 anti-tuberculosis drugs were INH (84 strains, 100.0%)>Sm (83 strains, 98.8%)>PAS (82 strains, 97.6%)>Am(77 strains, 91.7%)>Lfx=RFP (69 strains, 82.1%)>EMB (22 strains, 26.2%)>Pto (13 strains, 15.5%). Conclusion NTM-PD is common in elderly patients with respiratory diseases, negative γ-interferon release test can distinguish NTM lung disease from pulmonary tuberculosis early and timely. It has a high resistance rate to commonly used anti-tuberculosis drugs and is accompanied by great treatment difficulty. Early diagnosis and active drug sensitivity testing are of great importance.

Key words: Mycobacteria,atypica, Mycobacterial tuberculous, Disease attributes, Bacterial typing techniques, Microbial sensitivity tests

WANG Yi, LU Jing, LI Su-mei, ZHU Xue-feng, ZENG Ling-wu. Clinical characteristics and drug resistance of 84 patients with non-tuberculous mycobacterium pulmonary disease[J]. Journal of Tuberculosis and Lung Disease , 2021, 2(3): 223-227. doi: 10.3969/j.issn.2096-8493.20210054

Figures/Tables 2

References 19

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临床资料	NTM组(84例)		肺结核组(84例)		χ²值	P值
临床资料	例数	构成比或率(%)	例数	构成比或率(%)	χ²值	P值
并发疾病	38	45.2	27	32.1
慢性呼吸系统疾病	19	22.6	2	2.4	15.728	<0.001
高血压	12	14.3	10	11.9	0.209	0.647
糖尿病	4	4.8	12	14.3	4.421	0.035
心血管系统疾病	4	4.8	3	3.6	0.149	0.699
风湿系统疾病	3	3.6	3	3.6	0.000	1.000
恶性肿瘤	4	4.8	1	1.2	1.855	0.173
HIV感染	4	4.8	0	0.0	4.098	0.043
慢性肝病	1	1.2	4	4.8	1.855	0.173
临床表现
发热	23	27.4	3	3.6	18.202	<0.001
咳嗽	80	95.2	48	57.1	38.403	<0.001
咯血	25	29.8	8	9.5	10.898	0.001
胸闷	34	40.5	13	15.5	13.028	<0.001
影像学表现
双侧病灶	63	75.0	47	56.0	6.741	0.009
肺部空洞	32	38.1	18	21.4	5.581	0.018
支气管扩张	38	45.2	6	7.1	31.531	<0.001
斑点斑片影	81	96.4	79	94.0	0.525	0.469
γ-干扰素释放试验					98.536	<0.001
阳性	19	22.6	82	97.6
阴性	65	77.4	2	2.4

药品	胞内分枝杆菌 (58株)		堪萨斯分枝杆菌 (15株)		龟/脓肿分枝杆菌(6株)		鸟分枝杆菌 (3株)		草分枝杆菌 (1株)		偶然分枝杆菌 (1株)		合计
药品	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)	耐药株数	耐药率 (%)
异烟肼	58	100.0	15	100.0	6	6/6	3	3/3	1	1/1	1	1/1	84	100.0
利福平	56	96.6	2	13.3	6	6/6	3	3/3	1	1/1	1	1/1	69	82.1
乙胺丁醇	12	20.7	1	6.7	6	6/6	2	2/3	0	0/1	1	1/1	22	26.2
链霉素	58	100.0	15	100.0	6	6/6	3	3/3	0	0/1	1	1/1	83	98.8
阿米卡星	57	98.3	9	60.0	6	6/6	3	3/3	1	1/1	1	1/1	77	91.7
左氧氟沙星	55	94.8	3	20.0	6	6/6	3	3/3	1	1/1	1	1/1	69	82.1
对氨基水杨酸	56	96.6	15	100.0	6	6/6	3	3/3	1	1/1	1	1/1	82	97.6
丙硫异烟胺	7	12.1	0	0.0	6	6/6	0	0/3	0	0/1	0	0/1	13	15.5