Boyle F M, Georghiou P R, Tilse M H, McCormack J G
University of Queensland Department of Medicine, Mater Misericordiae Hospital, South Brisbane.
Med J Aust. 1991 May 6;154(9):592-6. doi: 10.5694/j.1326-5377.1991.tb121219.x.
To assess the pathogenic significance of Branhamella catarrhalis isolates in patients with respiratory infections and to define the clinical characteristics of such patients.
Respiratory specimens were assessed in a three-year prospective study performed in a Brisbane metropolitan hospital. Assessment of the pathogenic significance of isolates of B. catarrhalis was based on four predetermined criteria: (i) clinical evidence of respiratory infection based on history, examination and chest x-ray; (ii) isolation of B. catarrhalis as the sole potential pathogen; (iii) absence of antibiotic treatment in the previous two weeks; and (iv) subsequent clinical response to an antibiotic to which the isolate was sensitive.
B. catarrhalis was identified in 118 respiratory samples, 92 (78%) being from patients less than 10 years old. Infection with B. catarrhalis was more commonly seen in winter months and was community-acquired in two-thirds of cases. Isolation of this organism was associated with a broad variety of upper and lower respiratory tract syndromes. Isolates were considered to be of pathogenic significance (all four above criteria satisfied) in 35% of cases and of possible significance (the first and fourth criteria satisfied) in a further 15% of cases. Isolates were more likely to be of pathogenic significance in older patients and in those with pre-existing cardiorespiratory disease; however, a number of serious infections were observed in previously-well children. Expectorated sputum and tracheal aspirates were more likely to yield a clinically significant isolate than nasopharyngeal aspirates. Production of beta-lactamase was demonstrated in 88% of isolates.
B. catarrhalis causes respiratory infection more frequently than is generally appreciated. Isolation of this organism from the respiratory tract had pathogenic significance or possible pathogenic significance in 50% of our patients. If therapy is indicated in patients with respiratory infection caused by this organism, traditional beta-lactam regimens cannot be relied upon, as shown by the high rate of beta-lactamase production in this study; a tetracycline, erythromycin, a second or third generation cephalosporin, or the combination of a penicillin derivative and beta-lactamase inhibitor should be considered.
评估卡他布兰汉菌分离株在呼吸道感染患者中的致病意义，并明确此类患者的临床特征。
在布里斯班一家都市医院进行的一项为期三年的前瞻性研究中，对呼吸道标本进行了评估。基于以下四个预先确定的标准评估卡他布兰汉菌分离株的致病意义：（i）根据病史、检查和胸部X光得出的呼吸道感染临床证据；（ii）分离出卡他布兰汉菌作为唯一潜在病原体；（iii）前两周未接受抗生素治疗；（iv）随后对分离株敏感的抗生素的临床反应。
在118份呼吸道样本中鉴定出卡他布兰汉菌，其中92份（78%）来自10岁以下患者。卡他布兰汉菌感染在冬季更为常见，三分之二的病例为社区获得性感染。该菌的分离与多种上、下呼吸道综合征相关。在35%的病例中，分离株被认为具有致病意义（满足上述所有四个标准），另有15%的病例被认为可能具有致病意义（满足第一和第四个标准）。分离株在老年患者和患有心肺疾病的患者中更有可能具有致病意义；然而，在之前健康的儿童中也观察到了一些严重感染。咳出的痰液和气管吸出物比鼻咽吸出物更有可能产生具有临床意义的分离株。88%的分离株显示产β-内酰胺酶。
卡他布兰汉菌引起呼吸道感染的频率比一般认为的要高。在我们50%的患者中，从呼吸道分离出该菌具有致病意义或可能具有致病意义。如果对该菌引起的呼吸道感染患者进行治疗，由于本研究中β-内酰胺酶产生率较高，传统的β-内酰胺治疗方案不可靠；应考虑使用四环素、红霉素、第二代或第三代头孢菌素，或青霉素衍生物与β-内酰胺酶抑制剂的联合用药。
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