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Mycobacterium kansasii  is the second most common cause of slowly growing non-tuberculous mycobacteria diseases in China. The aim of the present study was to analyze  M. kansasii  subtypes isolated from patients in China, and to explore the antimicrobial susceptibility of the differentiation among these diverse subtypes. A total of 78  M. kansasii  strains from 16 provinces of China were enrolled in this study. Amikacin (AMK) was the most highly active against  M. kansasii  strains, and only 4 isolates (5.1%) exhibited  in vitro  resistance to AMK. The percentage of levofloxacin (LFX) resistant strains among the 78  M. kansasii  isolates was 39.7% (31/78), which was significantly higher than that of moxifloxacin (16.7%,  P  = 0.001) and gatifloxacin (19.2%,  P  = 0.005). By using PCR-restriction fragment analysis of the  hsp65  gene (PRA), all the isolates were classified as four different subtypes. Of these four subtypes,  M. kansasii  subtype I was the most frequent genotype in China, accounting for 71.8% (56/78) of  M. kansasii  isolates. Resistance to clarithromycin (CLA) was noted in 26.8% (15/56) of subtype I isolates, which was significant higher than that of other subtypes (4.5%,  P  = 0.031). DNA sequencing revealed that the presence of mutations in 23S rRNA was associated with 56.2% (9/16) of CLA-resistant  M. kansasii  isolates. In conclusion, our data demonstrate that AMK is the most active agent against  M. kansasii in vitro , while the high proportion of CLA resistance is noted in  M. kansasii  isolates. In addition, the predominant subtype I is associated with CLA resistance in China.

Mycobacterium kansasii Subtype I Is Associated With Clarithromycin Resistance in China