| Abstract：Objective This study aimed to characterize the clinical features and in vitro drug susceptibility testing (DST) patterns of non-tuberculous mycobacteria (NTM) infections in patients with diabetes mellitus (DM) in Hangzhou, thereby providing evidence to support individualized treatment strategies. Methods We retrospectively analyzed 40 patients diagnosed with NTM infection and DM at Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine between January 2018 and December 2021. Demographic and clinical data, comorbidities, imaging findings, and laboratory results were collected. Respiratory specimens were subjected to mycobacterial culture, species identification, and DST. Fisher’s exact test was applied to compare categorical variables across different NTM species. Results The cohort consisted mainly of males (55.0%) and elderly patients aged 60–80 years (62.5%). The Mycobacterium avium-intracellulare complex (MAC) was the most frequent isolate (72.5%), followed by the M. abscessus/chelonae group (20.0%) and M. kansasii (7.5%). Poor glycemic control was observed in 65.0% of cases. Species-specific differences were evident: patients with MAC and M. kansasii were more likely to have poor glycemic control, while those infected with the M. abscessus/chelonae group had higher rates of hypertension, hyperlipidemia, and hypoproteinemia. Radiologically, M. kansasii was more commonly associated with cavitary lesions (66.7%), the M. abscessus/chelonae group with nodules (50.0%) and pleural thickening (62.5%), whereas MAC was frequently linked to bronchiectasis (51.7%). DST revealed widespread resistance, with all isolates resistant to imipenem/cilastatin but universally susceptible to clarithromycin. The M. abscessus/chelonae group exhibited the broadest resistance profile, showing 100% resistance to rifampicin, ethambutol, and multiple other agents. Conclusion NTM infections in patients with DM demonstrate marked species-specific differences in clinical presentation and antimicrobial resistance. The M. abscessus/chelonae group showed particularly severe resistance patterns. These findings highlight the importance of precise species identification and DST to inform personalized therapeutic decisions and improve clinical outcomes. |
