脓肿分枝杆菌耐药机制、临床药敏检测及治疗研究进展

doi:10.3969/j.issn.1006-5725.2026.07.003

摘要/Abstract

摘要：

脓肿分枝杆菌复合群（Mycobacterium abscessus complex，MABC）是临床最常见的致病性快速生长非结核分枝杆菌，尤其易累及呼吸道，其快速生长和显著的亚种间耐药差异导致耐药感染治疗困难。本文综述MABC分子耐药机制，包括erm（41）基因介导的诱导性大环内酯耐药、rrl基因突变导致的获得性大环内酯耐药，以及氨基糖苷类药物耐药的靶点突变、修饰酶灭活及外排泵等机制，阐述亚种耐药差异及地理分布特点；总结临床药敏检测原则，强调亚种鉴定与表型、分子分型的整合应用；结合研究进展介绍耐药性MABC感染的多药联合治疗策略及试验性治疗手段，为临床精准诊断与个体化治疗提供参考，助力提升耐药性MABC感染诊治水平。

关键词: 脓肿分枝杆菌复合群, 快速生长分枝杆菌, 非结核分枝杆菌, 耐药, 抗感染治疗

Abstract:

The Mycobacterium abscessus complex （MABC） stands as the most prevalent clinically pathogenic rapidly-growing nontuberculous mycobacterium， with a distinct preference for the respiratory tract. Its rapid growth and substantial disparities in drug resistance among subspecies make the treatment of drug-resistant infections arduous. This article conducts a comprehensive review of the molecular mechanisms of drug resistance in MABC. These mechanisms include erm（41）-mediated inducible macrolide resistance， acquired macrolide resistance resulting from rrl gene mutations， and the mechanisms behind aminoglycoside resistance， such as target mutations， inactivation by modifying enzymes， and efflux pumps. It further details the subspecies-specific differences in drug resistance and the characteristics of geographical distribution. Moreover， it summarizes the principles of clinical drug susceptibility testing， highlighting the integrated application of subspecies identification， phenotypic detection， and molecular typing. Integrating the latest research advances， it presents multidrug combination therapy strategies and experimental therapeutic approaches for drug-resistant MABC infections. The aim is to offer references for clinical precision diagnosis and individualized treatment， and to contribute to enhancing the level of diagnosis and treatment of drug-resistant MABC infections.

Key words: Mycobacterium abscessus complex, rapidly growing mycobacteria, nontuberculous mycobacteria, drug resistance, anti-infective therapy

中图分类号:

R378.91

赖晓宇,陈珣珣,廖庆华,余美玲,郭卉欣,王嘉雯,陈瑜晖,温文沛. 脓肿分枝杆菌耐药机制、临床药敏检测及治疗研究进展[J]. 实用医学杂志, 2026, 42(7): 1134-1141.

Xiaoyu LAI,Xunxun CHEN,Qinghua LIAO,Meiling YU,Huixin GUO,Jiawen WANG,Yuhui CHEN,Wenpei WEN. Mechanisms of drug resistance， clinical drug susceptibility testing， and advances in treatment of Mycobacterium abscessus[J]. The Journal of Practical Medicine, 2026, 42(7): 1134-1141.

图/表 1

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亚种名称	erm（41）功能状态	rrl突变特点	核心耐药表型	主要地理分布	参考文献
脓肿亚种	功能性（可诱导激活）	初始分离株中可见突变，长期大环内酯暴露后突变频率显著上升	诱导性大环内酯耐药，易叠加rrl突变耐药	全球广泛分布，欧美地区检出率> 70%；中国华南地区为优势亚种（52.6%），北京、上海检出率73.8% ~ 75.9%	[9-11,16]
博莱亚种	功能性（可诱导激活）	相关研究数据十分有限，突变特征尚未明确	诱导性大环内酯耐药，氨基糖苷耐药风险高	全球散在分布，临床检出率相对较低	[7,19]
马赛亚种	失活型	初始检出率< 2%，耐药时多为rrl突变	天然大环内酯敏感，罕见诱导性耐药，耐药表型主要由 rrl突变介导	东亚地区为优势亚种之一（日本及中国台湾47.7%、中国华南地区45.4%）；泰国检出率58.1%，为最主要亚种	[7-8,19]