Abstract
BackgroundInformation on the prevalence and resistance spectrum of nontuberculous mycobacteria (NTM) in China is mainly based on regional or local data. To estimate the proportion of NTM cases in China, a national survey of NTM pulmonary disease was carried out based on acid-fast positive sputum samples collected in 2013.MethodsSputum samples collected from enrolled presumptive cases in 72 nationwide tuberculosis surveillance sites from the 31 provinces in the mainland of China were cultured using L-J medium at the National tuberculosis reference laboratory (NTRL). MALDI-TOF MS identified the species of re-cultured strains, and minimal inhibitory concentrations (MICs) were determined to evaluate the drug susceptibility of NTM isolates. Data analysis used statistical software SPSS version 22.0 for Windows statistical package.ResultsOf 4917 mycobacterial isolates cultured, 6.4% [317/4917, 95% confidence interval (CI) 5.8%–7.2%] were confirmed as NTM, among which 7.7% (287/3709, 95% CI 6.9%–8.6%) were from the southern region. In inland and coastal China, 87.7% (95% CI 78.7%–93.2%) and 50.0% (95% CI 43.7%–56.3%) of isolates, respectively, were slow-growing mycobacteria (SGM), with the remaining rapid growing mycobacteria (RGM). A total of 29 species were detected, Mycobacterium abscessus had higher clarithromycin-inducible resistance rates than M. massiliense (65.67% vs 2.22%). M. kansasii presented lower resistance rates in linezolid and moxifloxacin than M. avium-intracellulare complex (3.23% vs 66.67%, 0 vs 47.22%) and other SGM (3.23% vs 38%, 0 vs 26%).ConclusionsMore NTM pulmonary disease was observed in the south and coastal China (P < 0.01). SGM was widely distributed, and more RGM are present in southern and coastal China (P < 0.01). The antimicrobial resistance spectrum of different NTM species was significantly different and accurate species identification would be facilitated to NTM pulmonary disease treatment.
Highlights
Information on the prevalence and resistance spectrum of nontuberculous mycobacteria (NTM) in China is mainly based on regional or local data
The objectives of this study were to determine the proportion of NTM in isolated mycobacteria and determine their susceptibility to various antimicrobial drugs recommended by the United States Clinical and Laboratory Standards Institute (CLSI) in the mainland of China
Five strains were identified as Mycobacterium tuberculosis complex (MTBC)
Summary
Information on the prevalence and resistance spectrum of nontuberculous mycobacteria (NTM) in China is mainly based on regional or local data. To estimate the proportion of NTM cases in China, a national survey of NTM pulmonary disease was carried out based on acid-fast positive sputum samples collected in 2013. Nontuberculous mycobacteria (NTM) pulmonary disease (NTM-PD) is a severe progressive illness caused by non-tuberculous mycobacterium, requiring complicated treatment with multiple anti-mycobacterial drugs for more than 12 months [1]. Several studies have reported increased incidences of pulmonary NTM isolation, likely due to socioeconomic and medical progress, including advances in radiological diagnostics, which have improved the rate of detection of pulmonary abnormalities [2]. A meta-analysis indicted the proportion of NTM among mycobacterial isolates in China was higher than most regions in the whole world except that in Northern India [4].
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