- 學位論文
臺灣臨床上分離分枝桿菌株的趨勢研究
Trends of Mycobacterial Clinical Isolates in Taiwan
摘要
臨床上經常忽視可引起慢性肺部感染的非結核性分枝桿菌(non-tuberculous mycobacteria, NTM)。本回溯性研究分析台灣中部地區2002年到2007年疑似肺部分枝桿菌感染患者檢體中結核分枝桿菌(Mycobacterium tuberculosis complex, MTBC)與非結核性分枝桿菌的分離率。本研究從99,200份檢體中分離到5,349 株結核分枝桿菌與2,675 株非結核性分枝桿菌，共8,024株分枝桿菌。分枝桿菌之整體分離率為8.09% (8,024/99,200)，而結核分枝桿菌與非結核性分枝桿菌之整體分離率則分別為5.69% (5,349/99,200)與2.7% (2,675/99,200)。值得注意的是在所有分枝桿菌株中分離率為，非結核性分枝桿菌的分離率從2002年到2007年增加 2.6倍，從17.54% (147/838)大幅攀升為45.80% (659/1,439)。此外，結核分枝桿菌與非結核性分枝桿菌的分離率呈現互相消長的現象，非結核性分枝桿菌分離率逐年上升，但整體之分枝桿菌分離率在研究期間則保持穩定。為進一步提供非結核性分枝桿菌感染資訊、及早提供治療以降低非結核性分枝桿菌感染，本研究結果建議非結核性分枝桿菌的診斷、鑑定與抗生素感受性試驗應加以標準化，並納入臨床常規檢驗項目。
並列摘要
Non-tuberculous mycobacteria (NTM) can cause chronic pulmonary infection, however, NTM infection is generally overlooked. This retrospective study analyzed the frequencies of Mycobacterium tuberculosis complex (MTBC) and NTM clinical isolates from 99,200 specimens of patients suspected with pulmonary mycobacterial infection in Taiwan from year 2002 to 2007. A total of 8,024 mycobacterial isolates, including 5,349 MTBC and 2,675 NTM, were obtained among 99,200 specimens in the study period. The overall mycobacterial isolation rate was 8.09% (8,024/99,200), and the overall MTBC and NTM isolation rate was 5.69% (5,349/99,200) and 2.7% (2,675/99,200), respectively. Notably, the prevalence of NTM isolates among the identified mycobacteria strains was increased 2.6 folds from 2002 (17.54%, 147/838) to 2007 (45.80%, 659/1,439). The frequencies of MTBC and NTM isolates showed a reciprocal trend: the NTM isolation rates were steadily increasing while the overall mycobacterial isolation rates remained stable over the study period. Our results suggest that the diagnosis, identification and susceptibility tests for NTM should be standardized and integrated in clinical routine, for providing the information of NTM infection and prescribing clinical treatment in a more precise and efficient way to reduce the increasing NTM in the studied area.