Nontuberculous mycobacteria in China: incidence and antimicrobial resistance spectrum from a nationwide survey.
BACKGROUND
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.


METHODS
Sputum 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.


RESULTS
Of 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%).


CONCLUSIONS
More 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.
['Liu|Chun-Fa|CF|', 'Song|Yi-Meng|YM|', 'He|Wen-Cong|WC|', 'Liu|Dong-Xin|DX|', 'He|Ping|P|', 'Bao|Jing-Jing|JJ|', 'Wang|Xin-Yang|XY|', 'Li|Yan-Ming|YM|', 'Zhao|Yan-Lin|YL|http://orcid.org/0000-0002-4510-8643']
D000900:Anti-Bacterial Agents D002681:China D024881:Drug Resistance, Bacterial D015994:Incidence D009170:Nontuberculous Mycobacteria
Nontuberculous mycobacteria Prevalence Pulmonary disease Drug resistance