台灣某區域醫院分枝桿菌(Mycobacteria)的抗藥性調查

Antimicrobial Resistance Surveillance against Mycobacteria Isolated in a Regional Hospital in Taiwan

劉高林(Ko-Lin Liu) ； 呂汶紋(Wen-Wen Lu) ； 呂昀儒(Yun-Ju Lu) ； 陳媛孃(Yung-Liang Chen) ； 莊玉綉(Yu-Shiu Chuang) ； 施勇綸(Yung-Luen Shih) ； 侯心宇(Hsin-Yu Hou) ； 李明哲(Ming-Zhe Lee) ； 呂旭峰(Hsu-Feng Lu) ； 莊穎瑩(Ying-Ying Chuang) ； 廖年捷(Nien-Chieh Liao)

《檢驗及品保雜誌》 6卷2期 (2017/05) Pp. 92-101

https://doi.org/10.6573/JTQA.201705_6(2).04

摘要

本研究所使用的菌株來源為2014-2016 年北部某區域醫院從各類臨床檢體，主要為痰檢體所分離的878株分枝桿菌，檢體依據衛福部疾病管制署結核菌檢驗手冊建議的方法進行檢體處理、接種、分離、鑑定，結果顯示快速與慢速生長的非結核分枝桿菌(nontuberculous mycobacteria, NTM)以及結核分枝桿菌(Mycobacterium tuberculosis complex, MTBC)分別佔所有分枝桿菌的30.9%、36.6%以及23.9%。NTM 中分離率最高的分別為M. fortuitum 與M. avium complex。快速生長NTM對clarithromycin (CLR)、ciprofloxacin (CIP)、amikacin (AK)與moxifloxacin (MOX)感受性較高，然而，其中M. fortuitum 對CLR (4.0 μg/mL)的感受性僅22.8%，而M. abscessus 對moxifloxacin (MOX)與CIP 的感受性分別為12.3%及8.8%。另外，慢速生長NTM 中的M. avium complex(MAC)，對CLR (16 μg/mL)的感受性最佳，其次是MOX (85.2%)與ethambutol (68%)，較差的是isoniazid (54.9%)。此外，分析MTBC 的抗藥性發現，其對isoniazid (0.2 μg/mL)、isoniazid (1.0 μg/mL)、rifampin (1.0 μg/mL)、ethambutol (5.0 μg/mL)、ethambutol (10 μg/mL)、streptomycin (2.0 μg/mL)與streptomycin (10 μg/mL)的感受性分別為91.9%、96.7%、99.5%、100%、100%、91.9%與96.2%。並且發現1 位（0.49%，1/210）多重抗藥性病患，其對isoniazid (0.2 μg/mL)與rifampin (1.0 μg/mL)呈抵抗性。本研究測試分枝桿菌的鑑定方法包括以抗MPB64 單株抗體偵測結核菌結的分泌型蛋白MPB64 的免疫層析法以及生物晶片CMP^(TM) MycoChip 與新一代的CMP^(TM) MycoCheck。綜合上述，本研究指出(i)目前台灣臨床分枝桿菌中NTM與MTBC的分離比例約為2:1；(ii)有些NTM的抗藥性有增加的趨勢；與(iii) CMP^(TM) MycoCheck 可協助臨床快速進行NTM 菌種鑑定，有利於即時進行NTM 精選肉湯稀釋藥敏試驗。

關鍵字

結核分枝桿菌(MTBC) ； 非結核分枝桿菌(NTM) ； 藥敏型式 ； 多重抗藥性 ； 免疫層析法 ； MycoCheck

並列摘要

Mycobacterium tuberculosis complex (MTBC) is responsible for 1.8 million deaths annually, and there is an urgent need for correct treatments of antituberculosis drugs on account of the emergence of a serious threat for the control of the multidrug-resistant tuberculosis pandemic. Nontuberculous mycobacterium (NTM) inclusive of fast-growing and slow-growing mycobacterium raises radically different issues as an important opportunistic pathogen for many kinds of infections. Smear microscopy is an inexpensive method for rapid detection of mycobacteria; however, it cannot differentiate MTBC from NTM. Therefore, detection of mycobacterial growth in culture media is necessary for definite diagnosis of MTBC and NTM, although this method requires several weeks before results can be obtained. My colleague and I applied simple and rapid identification of the MTBC by immunochromatographic assay using anti-MPB64 monoclonal antibodies, and CMP^(TM) MycoChip and MycoCheck methods to identify 878 isolates of mycoba cteria collected from a certain regional hospital from year 2014 to 2016. Our study revealed that slowly growing mycobacteria accounts for 36.6% of the total, followed by rapidly growing mycobacteria (30.9%) and MTBC (23.9%). Among the rapidly and slowly growing mycobacteria, the highest isolation rate was M. fortuitum and MAC individually. The susceptibilities of rapidly growing mycobacteria to clarithromycin (CLR), ciprofloxacin (CIP), amikacin (AK) and moxifloxacin (MOX) were higher, except M. fortuitum to CLR with 4.0 μg/mL (22.8%), and M. abscessus to MOX (12.3%) and CIP (8.8%). The susceptibilities of MAC to CLR with 16 μg/mL was highest with MOX (85.2%) and ethambutol (68%) coming next, followed isoniazid (54.9%). Results also indicated that the susceptibilities of MTBC to isoniazid (0.2 μg/mL), isoniazid (1.0 μg/mL), rifampin (1.0 μg/mL), ethambutol (5.0 μg/mL), ethambutol (10 μg/mL), streptomycin (2.0 μg/mL) and streptomycin (10 μg/mL) were 91.9%, 96.7%, 99.5%, 100%, 100%, 91.9% and 96.2%, separately. The prevalence rate of multiple drugresistance MTBC was 0.48% (1/210). This study provided further insight into the prevalence and antibiotic resistance rate of TB and NTM, and this result was similar to those of some early experimental findings and previous reports. It should be noted that different methods may lead to different results inclusive of correct reports, time effective and labor intensive. In this study, immunochromatographic assay using anti- MPB64 monoclonal antibodies, and CMP^(TM) MycoChip and MycoCheck methods can facilitate to identify mycobacteria into species and to antibiotic treatments.

並列關鍵字

MTBC ； nontuberculous mycobacteria ； multidrug-resistant ； antibiograms ； immunochromatographic assay ； MycoCheck