最近,鸟分枝杆菌复合体(MAC)感染一直在增加,尤其是在免疫功能低下和老年人中。由于有限的治疗策略和长期药物造成的不利影响,这种快速增长引发了全球健康关注。为MAC的治疗提供更多的证据,我们研究了17种抗菌药物对临床MAC分离株的体外抑制活性。
本研究共纳入111个临床MAC分离株,它们被鉴定为细胞内分枝杆菌,M.avium,M.Marseillense,哥伦比亚M.M.yongonense,在物种水平上无法鉴定出两个分离株。MAC菌株对克拉霉素的耐药性相对较低(0-21.6%),阿米卡星,bedaquiline,rifabutin,链霉素,和氯法齐明,以及对异烟肼的耐药率,利福平,利奈唑胺,多西环素,和乙硫酰胺非常高(72.1-100%)。此外,鸟分枝杆菌对乙胺丁醇的耐药率明显高于胞内分枝杆菌(92.3%vs40.7%,P<0.001),阿米卡星(15.4%对1.2%,P=0.049),和环丝氨酸(69.2%对25.9%,P=0.004)。
我们的结果支持大环内酯类的当前使用,rifabutin,和治疗MAC感染的方案中的氨基糖苷类,还证明了对新药的低耐药率,如氯法齐明,替迪唑胺,还有bedaquiline,提示这些药物在MAC治疗中的可能实施。
Recently, Mycobacterium avium complex (MAC) infections have been increasing, especially in immunocompromised and older adults. The rapid increase has triggered a global health concern due to limited therapeutic strategies and adverse effects caused by long-term medication. To provide more evidence for the treatment of MAC, we studied the in vitro inhibitory activities of 17 antimicrobial agents against clinical MAC isolates.
A total of 111 clinical MAC isolates were enrolled in the study and they were identified as M. intracellulare, M. avium, M. marseillense, M. colombiense, M. yongonense, and two isolates could not be identified at the species level. MAC strains had relatively low (0-21.6%) resistance to clarithromycin, amikacin, bedaquiline, rifabutin, streptomycin, and clofazimine, and the resistant rates to isoniazid, rifampin, linezolid, doxycycline, and ethionamide were very high (72.1-100%). In addition, M. avium had a significantly higher resistance rate than that of M. intracellulare for ethambutol (92.3% vs 40.7%, P < 0.001), amikacin (15.4% vs 1.2%, P = 0.049), and cycloserine (69.2% vs 25.9%, P = 0.004).
Our results supported the current usage of macrolides, rifabutin, and aminoglycosides in the regimens for MAC infection, and also demonstrated the low resistance rate against new drugs, such as clofazimine, tedizolid, and bedaquiline, suggesting the possible implementation of these drugs in MAC treatment.