背景:中国是结核病的高负担国家。非结核分枝杆菌(NTM)引起的疾病比例增加,严重影响预防,control,和结核病(TB)的管理,对人类健康构成重大威胁。然而,缺乏有组织的NTM监测系统,例如用于结核病的监测系统。关于患者易感性的综合数据,优势种,和耐药谱需要改善NTM的治疗方案和管理。方法:从四个在线资源(BIOSIS,检索2000年1月1日至2019年5月31日发表的中国大陆NTM临床标本的初步研究报告,Embase,PubMed,和WebofScience)和三个中国医学文献数据库(CNKI,万方,和Vip)作为系统评价和荟萃分析的首选报告项目。结果:总的来说,系统审查包括339份出版物,129例用于药敏分析,95例用于荟萃分析。传统培养采用Lowenstein-Jensen斜面结合对硝基苯酸和噻吩-2-羧酸肼微分培养基和比例法最常用于分离,identification,NTM在中国的药敏试验。结核病疑似病例中NTM的粗隔离率为4.66-5.78%,分枝杆菌中NTM的比例为11.57%。脓肿分枝杆菌和鸟分枝杆菌复合物是最常见的临床NTM物种。NTM仅显示出对乙胺丁醇的一般敏感性,利奈唑胺,氯法齐明,阿米卡星,妥布霉素,还有克拉霉素.结论:我国NTM患病率呈下降趋势。在研究过程中,脓肿分枝杆菌被细胞内分枝杆菌取代为优势种。不同物种的地理多样性显示了环境和经济因素对NTM分布的影响,表明仍有重要因素尚未确定。虽然只有有限数量的抗生素对NTM显示出任何敏感性,分离株的耐药谱差异很大,因此在经验治疗NTM感染时应更加谨慎.
Background:
China is a high-burden country of tuberculosis. The proportion of diseases caused by non-tuberculous mycobacteria (NTM) has increased, seriously affecting the prevention, control, and management of tuberculosis (TB) and posing a significant threat to human health. However, there is a lack of an organized monitoring system for NTM such as that used for tuberculosis. Comprehensive data on patient susceptibility, dominant species, and drug resistance profiles are needed to improve the treatment protocols and the management of NTM. Methods: Primary research reports of NTM clinical specimens from mainland
China published between January 1, 2000 and May 31, 2019 were retrieved from four online resources (BIOSIS, Embase, PubMed, and Web of Science) and three Chinese medical literature databases (CNKI, Wanfang, and Vip) as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: In total, 339 publications were included in the systematic review, 129 were used in the drug susceptibility analysis, and 95 were used in the meta-analysis. Traditional culture using Lowenstein-Jensen slants combined with P-nitrobenzene acid and thiophene-2-carboxylic acid hydrazine differential medium and proportional method was most commonly used for the isolation, identification, and drug susceptibility testing of NTM in
China. The crude isolation rate for NTM among TB suspected cases was 4.66-5.78%, while the proportion of NTM among Mycobacterium isolates was 11.57%. Mycobacterium abscessus and Mycobacterium avium complex were the most common clinical NTM species. NTM only showed general sensitivity to ethambutol, linezolid, clofazimine, amikacin, tobramycin, and clarithromycin. Conclusions: The prevalence of NTM in
China has shown a decreasing trend. M. abscessus was replaced as the dominant species by Mycobacterium intracellulare over the course of the study. The geographic diversity of different species showed the effects of environmental and economic factors on the distribution of NTM and indicated that there were important factors still not identified. While there were only a limited number of antibiotics to which NTM showed any sensitivity, the drug resistance profiles of the isolates were highly variable and thus more caution should be taken when empirically treating NTM infection.