San Gabriel Pablo, Zhou Juyan, Tabibi Setareh, Chen Yunhua, Trauzzi Marco, Saiman Lisa
Department of Pediatrics, Columbia University, New York, New York 10032, USA.
Antimicrob Agents Chemother. 2004 Jan;48(1):168-71. doi: 10.1128/AAC.48.1.168-171.2004.
Stenotrophomonas maltophilia is a newly emerging pathogen being detected with increasing frequency in patients with cystic fibrosis (CF). The impact of this multidrug-resistant organism on lung function is uncertain. The optimal treatment for S. maltophilia in CF patients is unknown. We studied the in vitro activity of ten antimicrobial agents, and conducted synergy studies by using checkerboard dilutions of eight pairs of antimicrobial agents against strains isolated from 673 CF patients from 1996 to 2001. This represents approximately 7 to 23% of the CF patients in the United States who harbor S. maltophilia annually. Doxycycline was the most active agent and inhibited 80% of 673 initial patient isolates, while trimethoprim-sulfamethoxazole inhibited only 16%. High concentrations of colistin proved more active than high concentrations of tobramycin and gentamicin. Serial isolates (n = 151) from individual patients over time (median, 290 days) showed minimal changes in resistance. Synergistic or additive activity was demonstrated by trimethoprim-sulfamethoxazole paired with ticarcillin-clavulanate (65% of strains), ciprofloxacin paired with ticarcillin-clavulanate (64% of strains), ciprofloxacin paired with piperacillin-tazobactam (59% of strains), trimethoprim-sulfamethoxazole paired with piperacillin-tazobactam (55% of strains), and doxycycline paired with ticarcillin-clavulanate (49% of strains). In all, 522 (78%) isolates were multidrug resistant (i.e., resistant to all agents in two or more antimicrobial classes) but 473 (91%) of these were inhibited by at least one antimicrobial combination (median, four; range, one to eight). To determine appropriate treatment for patients with CF, it is important to monitor the prevalence, antimicrobial susceptibility, and clinical impact of S. maltophilia in this patient population.
嗜麦芽窄食单胞菌是一种新出现的病原体，在囊性纤维化（CF）患者中检测到的频率越来越高。这种多重耐药菌对肺功能的影响尚不确定。CF患者中嗜麦芽窄食单胞菌的最佳治疗方法尚不清楚。我们研究了十种抗菌药物的体外活性，并通过棋盘稀释法对1996年至2001年从673例CF患者分离出的菌株进行了八对抗菌药物的协同研究。这约占美国每年携带嗜麦芽窄食单胞菌的CF患者的7%至23%。强力霉素是最有效的药物，抑制了673例初始患者分离株中的80%，而甲氧苄啶-磺胺甲恶唑仅抑制了16%。高浓度的黏菌素比高浓度的妥布霉素和庆大霉素更具活性。随时间推移（中位数为290天）从个体患者分离出的系列菌株（n = 151）显示耐药性变化极小。甲氧苄啶-磺胺甲恶唑与替卡西林-克拉维酸（65%的菌株）、环丙沙星与替卡西林-克拉维酸（64%的菌株）、环丙沙星与哌拉西林-他唑巴坦（59%的菌株）、甲氧苄啶-磺胺甲恶唑与哌拉西林-他唑巴坦（55%的菌株）以及强力霉素与替卡西林-克拉维酸（49%的菌株）配对显示出协同或相加活性。总共522株（78%）分离株对多种药物耐药（即对两种或更多抗菌药物类别中的所有药物耐药），但其中473株（91%）被至少一种抗菌药物组合抑制（中位数为四种；范围为一至八种）。为了确定CF患者的适当治疗方法，监测嗜麦芽窄食单胞菌在该患者群体中的流行情况、抗菌药物敏感性和临床影响非常重要。
