Keays Tara, Ferris Wendy, Vandemheen Katherine L, Chan Francis, Yeung Sau-Wai, Mah Thien-Fah, Ramotar Karam, Saginur Raphael, Aaron Shawn D
The Ottawa Health Research Institute, University of Ottawa, ON, Canada.
J Cyst Fibros. 2009 Mar;8(2):122-7. doi: 10.1016/j.jcf.2008.10.005. Epub 2008 Dec 7.
Bacteria grow as biofilms within CF airways. However, antibiotic susceptibility testing is routinely performed on planktonically-growing bacteria. This study assessed whether CF patients infected with multiresistant organisms had improved clinical outcomes if given antibiotics that inhibited their biofilm-grown bacteria.
110 patients with pulmonary exacerbations were treated with intravenous antibiotics based on susceptibility testing of planktonically-growing bacteria. A retrospective analysis was done using bacterial isolates grown from their sputum at exacerbation. Each isolate was grown as a biofilm and combination antibiotic susceptibility testing was performed. Clinical outcomes in patients treated with biofilm-susceptible antibiotics were compared to those that were not.
66 of 110 patients (60%) were treated with antibiotic combinations that inhibited all of their planktonically-grown bacterial isolates, however, when the same isolates were grown as biofilms, only 24 patients (22%) had all of their biofilm-grown isolates remaining susceptible to the antibiotics (P=<0.001 ). When patients with at least one biofilm-grown susceptible isolate (n=61) were compared to those with none (n=49), there was a significant decrease in sputum bacterial density (P=0.02) and length of stay (P=0.04) and a non-significant decrease in treatment failure. Survival analyses of time to next exacerbation showed non-significant trends favoring patients treated with biofilm-effective antibiotics.
Most patients with CF exacerbations do not receive antibiotics that inhibit all biofilm-grown bacteria from their sputum at exacerbation. Patients treated with biofilm-effective therapy seemed to have improved clinical outcomes.
细菌在囊性纤维化（CF）气道内以生物被膜的形式生长。然而，抗生素敏感性测试通常是针对浮游生长的细菌进行的。本研究评估了感染多重耐药菌的CF患者使用能抑制其生物被膜生长细菌的抗生素后，临床结局是否有所改善。
110例肺部病情加重的患者根据浮游生长细菌的药敏试验接受静脉抗生素治疗。利用病情加重时从痰液中分离出的细菌进行回顾性分析。每种分离菌均培养成生物被膜，并进行联合抗生素敏感性测试。将接受生物被膜敏感抗生素治疗的患者的临床结局与未接受该治疗的患者进行比较。
110例患者中有66例（60%）接受了能抑制其所有浮游生长细菌分离株的抗生素联合治疗，然而，当相同的分离菌培养成生物被膜时，只有24例患者（22%）的所有生物被膜生长分离株仍对这些抗生素敏感（P<0.001）。将至少有一株生物被膜生长敏感分离株的患者（n=61）与没有此类分离株的患者（n=49）进行比较，痰液细菌密度显著降低（P=0.02），住院时间显著缩短（P=0.04），治疗失败率有非显著性降低。对下次病情加重时间的生存分析显示，倾向于接受生物被膜有效抗生素治疗患者的趋势不显著。
大多数CF病情加重的患者在病情加重时未接受能抑制痰液中所有生物被膜生长细菌的抗生素治疗。接受生物被膜有效治疗的患者临床结局似乎有所改善。
