| 摘要: | 非結核分枝桿菌(nontuberculous mycobacteria, NTM)存在於我們周遭環境中，非結核分枝桿菌是屬於伺機性感染的病原體，不會人傳人。NTM可引發許多不同的疾病，然而NTM的治療方針與菌種之間存在著非常大的差異，因此NTM的鑑定就顯得非常的重要。
本研究依據美國胸腔醫學會(American Thoracic Society, ATS) 和美國感染症醫學會(Infectious Diseases Society of America, IDSA)所建議的NTM感染定義篩選可能的感染菌株，再使用多套式聚合?鏈鎖反應(multiplex polymerase chain reactions, Multiplex PCR) 以及限制性片段長度多態性(restriction fragment length polymorphism, RFLP)兩種分子生物方法進行感染菌種鑑定，最後將鑑定結果進行統計以呈現菌種分布的情形。
研究期間分枝桿菌培養檢體總送檢件數27076件，培養陽性2788件，培養陽性率10.3%。其中Mycobacterium tuberculosis complex (MTBC)有796件，MTBC陽性率28.55%。NTM有1992件，NTM陽性率71.45%。依據2007年美國胸腔醫學會(ATS)的建議標準，將以上NTM培養陽性件數套用標準之後，其符合感染標準的件數共有799件。再將感染菌種件數使用歸人統計加以分析，經統計後總共有424例。結果發現感染菌株以MAC為最多，有237株，陽性率55.9%。第二名為M. abscessus，有58株，陽性率13.7%。第三名為無法鑑定之NTM，有50株，陽性率11.8%。第四名為M. fortuitum，有24株，陽性率5.7%。第五名M. simiae，有15株，陽性率3.5%。第六名變成M. gordonae，有13株，陽性率3.1%。第七名則是M. kansasii，有10株，陽性率2.4%。研究期間還有3例眼科角膜感染病患，皆是M. abscessus，有可能是群聚感染現象。病人屬性調查發現男性比女性還多，並且年齡主要集中在51歲到90歲之間，有362人，佔85.4%。
本研究採用ATS感染定義加上歸人統計方式，與一般臨床微生物實驗室採用NTM培養陽性件數統計方式，比較結果更能反映臨床感染的趨勢。此研究結果可提供臨床醫師與衛生單位做為參考。
Nontuberculous mycobacteria (NTM), organisms ubiquitous in our environment, are opportunistic pathogens that are not transmitted by humans. Such NTM infections can cause many different diseases and syndromes. However, there are many differences among the strains of NTM, leading to different treatment schemes, so the identification of NTM is very important. This study identified possible infectious strains based on the NTM infection definition suggested by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). Multiple polymerase chain reactions (Multiplex PCR) and restriction fragment length polymorphism (RFLP) were used to identify bacterial strains. Finally, the identification results were tabulated to determine the incidence and prevalence of infections.
During the study period, of the 27,076 mycobacteria culture specimens that were examined, 2788 were culture positive with a culture positive rate of 10.3%. Of those positive cultures, 796 of them were MTBCs (28.55%) and 1992 of them were NTM (71.45%). Following the 2007 American Thoracic Society (ATS) guidelines, the total number of confirmed cases that met infection criteria was 799. Statistical analysis was performed, identifying 424 cases. The results showed that the MAC strains were the most common with 237 strains (55.9%). M. abscessus was second most common, with 58 strains(13.7%). Other cases, in order of decreasing incidence, included an unidentifiable NTM with 50 strains (11.8%), M. fortuitum, with 24 strains (5.7%), M. simiae with 15 strains (3.5%), M. gordonae with 13 strains (3.1%), M. kansasii with 10 strains (2.4%). There were 3 cases of corneal infections during the study, with M. abscessus as the infectious agent. There may be cluster infections. The patient characteristics survey found that there were more men than women, and the age was mainly between 51 and 90 years old.
In this study, the ATS infection definition was incorporated to the count the results of the culture positive cases. Compared with the general clinical microbiology laboratory, the number of positive cultures using NTM was used to count the number of cases. The comparison results were more representative of the trend of clinical infection. The results of this study can provide clinicians and health units with clinical reference to guide diagnostic reasoning. |
