慢速生長非結核分枝桿菌（Nontuberculous Mycobacteria）台灣分離株的藥敏型式

Slow-Growing Nontuberculous Mycobacteria Antimicrobial Susceptibility of Isolated Strains in Taiwan

韓之詅(Chi-Liing Han) ； 吳佩真(Pei-Chen Wu) ； 李秀霞(Hsiu-Hsia Li) ； 蔡岳廷(Yueh-Ting Tsai) ； 蔡文城(When-cherng Tsai)

《檢驗及品保雜誌》 4卷1期 (2015/02) Pp. 8-15

https://doi.org/10.6573/JTQA.201502_4(1).02

摘要

近年來，台灣的慢速生長非結核分枝桿菌（nontuberculous mycobacteria, NTM）有增加的趨勢，本研究室隨機選取從臨床分離的八種慢速生長NTM菌種共613株以精選大管肉湯稀釋方法進行藥敏試驗，根據CLSI建議的各菌種對不同藥物感受判讀標準，指出M. avium complex（MAC）對clarithromycin（CLA）、moxifloxacin（MOX）、linezolid（LZD）與ethambutol（EMB）的感受性分別為96%、88%、64%與84%，而M.kansasii、M. terrae及M. xenopi等菌種對CLA、ciprofloxacin（CIP）與trimethoprim-sulfamethoxazole（SXT）至少有80%以上的感受性，對streptomycin（SM）、amikacin（AK）、EMB，MOX與LZD的感受性亦皆為90%以上，尤其，各菌種對LZD的感受性均為100%。值得一提的是M. sulgai對rifampin（RMP）以及M.malmoense對isoniazid（INH）呈抵抗性，但測試菌株僅1株。另外M. gordonae對RMB、EMB、LZD皆有至少87.5%以上的感受性，但對SM的感受性僅為70%。鑑於CLSI所建議微量肉湯稀釋方法的應用限制性以及精選大管肉湯稀釋方法操作的簡易性、培養基取得的方便性以及獲得藥敏型式的快速性、一致性與穩定性，吾等建議分枝桿菌檢驗室可將精選大管肉湯稀釋方法納入慢速生長NTM的常規藥敏試驗中。另外，本研究亦發現慢速生長NTM藥敏試驗的培養基大多類別在配製後至少第四週才開始失效（由感受性轉變為抵抗性），其中MAC與M. kansasii的測試培養基甚至直到第五週才失效，顯示廠家對藥敏試驗培養基的有效期訂為三週是合理的。

關鍵字

精選大管肉湯稀釋方法 ； 慢速生長分枝桿菌 ； 藥敏試驗

並列摘要

In recent years, slow-growing nontuberculous mycobacteria (NTM) has been showing an increasing trend in Taiwan. Our laboratory randomly selected 8 species of slow-growing NTM from clinical isolates and a total of 613 strains were tested for antimicrobial susceptibility using limited macrobroth dilution method. According to the standards recommended by CLSI for interpreting the susceptibility of different species to different drugs, the susceptibility of M. avium complex (MAC) to clarithromycin (CLA), moxifloxacin (MOX), linezolid (LZD) and ethambutol (EMB) is 96%, 88%, 64% and 84% respectively. While strains such as M. kansasii, M. terrae and M. xenopi have at least 80% susceptibility to CLA, ciprofloxacin (CIP) and trimethoprim-sulfamethoxazole (SXT). With regards to streptomycin (SM), amikacin (AK) and EMB, the susceptibility to MOX and LZD are both above 90%, in particular, the susceptibility of various species to LZD was 100%. It is worth mentioning that M. sulgai was resistant to rifampin (RMP) and M. malmoense was resistant to isoniazid (INH) but only 1 strain was tested. In addition, M. gordonae has at least 87.5% susceptibility to RMB, EMB, LZD but only 70% susceptibility to SM. Given the limited applications of the microbroth dilution method recommended by CLSI, the ease of implementing the limited macrobroth dilution method, the convenience of acquiring culture media, and the efficiency, consistency and stability of obtaining antimicrobial susceptibility, it is recommended that mycobacteria laboratories can include the macrobroth dilution method into the routine susceptibility testing of slow-growing NTM. In addition, this study also found that in slow-growing NTM susceptibility tests, most types of culture media for antimicrobial susceptibility testing began to lose effectiveness (changed from susceptible to resistant) only after the 4th week from preparation. Among these, the culture media of MAC and M. kansasii did not lose effectiveness until the 5th week. This shows that the 3 week validity period of culture media for antimicrobial susceptibility testing set by the manufacturers is reasonable.

並列關鍵字

Slow-growing nontuberculous mycobacteria ； Antimicrobial susceptibility ； Macrobroth dilution method