肺部感染常見的慢速生長分枝桿菌之快速鑑定及藥敏分析

Rapid identification and drug susceptibility of the most common slowly growing mycobacteria infection in pulmonary disease

慢速生長分枝桿菌（slowly growing mycobacteria, SGM）感染人類最常見的是鳥分枝桿菌群（Mycobacterium avium complex, MAC），其次為堪薩斯分枝桿菌（Mycobacterium kansasii），兩者均可引起人類肺病，MAC更可引起成人頸部淋巴結發炎及在HIV病人引起播散性感染疾病。本研究目的是利用寡核苷酸晶片檢測方法，快速鑑別MAC與M. kansasii，再以商業化Sensititre® SLOMYCO panel （TREK Diagnostic Systems, Ltd, UK）藥敏試驗套組，測試MAC與M. kansasii藥物感受性結果。研究檢體取自台灣南部某區域教學醫院分枝桿菌陽性培養之呼吸道檢體。經寡核苷酸晶片檢測出MAC分離菌株225株及M. kansaii 15株。再使用Sensititre® SLOMYCO panel肉湯微量稀釋法檢測藥敏試驗。檢測結果MAC分離菌株對clarithromycin藥物感受性結果為85.8％，moxifloxacin為8.9％，linezolid為2.2％。M. kansasii對clarithromycin藥物感受性的結果為100％，對amikacin、linezolid、moxifloxacin感受性為67％，對於其他藥物如rifampin、ethambutol、ciprofloxacin及trimethoprim－sulfamethoxazole等則有較高抗藥性結果。因此，本研究結果可作為MAC及M. kansasii感染肺部的實驗診斷及治療的參考。本次實驗因限於M. kansaii檢體分離數較少，未來可再增加收集檢體數測試，以獲得更充分的藥敏試驗結果。

The most common slowly growing mycobacteria (SGM) infection in humans is Mycobacterium avium complex (MAC), followed by Mycobacterium kansasii. Both can cause pulmonary disease. MAC can cause cervical lymphadenitis in adults and disseminated infections in HIV patients. The purpose of the study is using the oligonucleotide microarrays method to quickly identify slow-growing MAC and M. kansasii. Drug susceptibility for MAC and M. kansasii were tested using the Sensititre® SLOWMYCO plate (TREK Diagnostic Systems, Ltd, UK). The research specimens of respiratory tract positive for mycobacterium were taken from a regional teaching hospital in southern Taiwan. Totally, 225 MAC strains and 15 M. kansasii strains were detected. Drug susceptibility for NTM was tested using the Sensititre® SLOWMYCO plate (TREK Diagnostic Systems, Ltd, UK). MICs were established by broth microdilution method. The results showed that the 85.8 % of MAC isolates were susceptible to clarithromycin, 8.9% to moxifloxacin and 2.2% to linezolid. 100% of M. Kansasii isolates were susceptible to clarithromycin and the susceptibility to amikacin, linezolid and moxifloxacin were 67%. M. Kansasii isolates revealed highly resistant to several drugs such as rifampin, ethambutol, ciprofloxacin, and trimethoprim-sulfamethoxazole. Therefore, the results of this study can be used as a reference for the diagnosis and treatment of MAC and M. kansasii infection in pulmonary disease. Due to the limited number of M. kansaii samples, the number of samples collected in the experiment can be increased in the future to obtain more representative findings.