毒力因子在 CAPD 患者金黄色葡萄球菌性腹膜炎结局中的作用。
The role of virulence factors in the outcome of staphylococcal peritonitis in CAPD patients.
机构信息
Department of Microbiology and Immunology, Biosciences Institute, UNESP, Botucatu, Sao Paulo, Brazil.
出版信息
BMC Infect Dis. 2009 Dec 22;9:212. doi: 10.1186/1471-2334-9-212.
BACKGROUND
Peritonitis continues to be the most frequent cause of peritoneal dialysis (PD) failure, with an important impact on patient mortality. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase-negative staphylococci (CoNS), and Staphylococcus aureus are the most frequent etiological agents of PD-associated peritonitis worldwide. The objective of the present study was to compare peritonitis caused by S. aureus and CoNS and to evaluate the factors influencing outcome.
METHODS
Records of 86 new episodes of staphylococcal peritonitis that occurred between 1996 and 2000 in the Dialysis unit of a single university hospital were studied (35 due to S. aureus, 24 to S. epidermidis and 27 to other CoNS). The production of slime, lipase, lecithinase, nuclease (DNAse), thermonuclease (TNAse), alpha- and beta-hemolysin, enterotoxins (SEA, SEB, SEC, SED) and toxic shock syndrome toxin-1 (TSST-1) was studied in S. aureus and CoNS. Antimicrobial susceptibility was evaluated based on the minimal inhibitory concentration determined by the E-test. Outcome predictors were evaluated by two logistic regression models.
RESULTS
The oxacillin susceptibility rate was 85.7% for S. aureus, 41.6% for S. epidermidis, and 51.8% for other CoNS (p = 0.001). Production of toxins and enzymes, except for enterotoxin A and alpha-hemolysin, was associated with S. aureus episodes (p < 0.001), whereas slime production was positive in 23.5% of CoNS and 8.6% of S. aureus strains (p = 0.0047). The first model did not include enzymes and toxins due to their association with S. aureus. The odds of resolution were 9.5 times higher for S. epidermidis than for S. aureus (p = 0.02) episodes, and were similar for S. epidermidis and other CoNS (p = 0.8). The resolution odds were 68 times higher for non-slime producers (p = 0.001) and were not influenced by oxacillin resistance among vancomycin-treated cases (p = 0.89). In the second model, the resolution rate was similar for S. aureus and S. epidermidis (p = 0.70), and slime (p = 0.001) and alpha-hemolysin (p = 0.04) production were independent predictors of non-resolution.
CONCLUSION
Bacterial species and virulence factors rather than antibiotic resistance influence the outcome of staphylococcal peritonitis.
背景
腹膜炎仍然是腹膜透析（PD）失败的最常见原因，对患者死亡率有重要影响。表皮葡萄球菌、其他凝固酶阴性葡萄球菌（CoNS）和金黄色葡萄球菌等革兰氏阳性球菌是全球 PD 相关性腹膜炎的最常见病因。本研究旨在比较金黄色葡萄球菌和 CoNS 引起的腹膜炎，并评估影响结果的因素。
方法
研究了 1996 年至 2000 年期间在一家大学医院透析科发生的 86 例新的葡萄球菌性腹膜炎发作的记录（35 例由金黄色葡萄球菌引起，24 例由表皮葡萄球菌引起，27 例由其他 CoNS 引起）。研究了金黄色葡萄球菌和 CoNS 中产黏液、脂肪酶、卵磷脂酶、核酸酶（DNAse）、热核酸酶（TNAse）、α-和β-溶血素、肠毒素（SEA、SEB、SEC、SED）和中毒性休克综合征毒素-1（TSST-1）。根据 E 试验确定的最小抑菌浓度评估抗菌药物敏感性。通过两个逻辑回归模型评估预后预测因子。
结果
金黄色葡萄球菌的苯唑西林敏感性率为 85.7%，表皮葡萄球菌为 41.6%，其他 CoNS 为 51.8%（p=0.001）。毒素和酶的产生，除肠毒素 A 和α-溶血素外，与金黄色葡萄球菌发作有关（p<0.001），而黏液产生在 23.5%的 CoNS 和 8.6%的金黄色葡萄球菌菌株中呈阳性（p=0.0047）。由于它们与金黄色葡萄球菌有关，第一个模型未包括酶和毒素。表皮葡萄球菌的缓解几率是金黄色葡萄球菌的 9.5 倍（p=0.02），表皮葡萄球菌和其他 CoNS 的缓解几率相似（p=0.8）。非黏液产生者的缓解几率高 68 倍（p=0.001），万古霉素治疗病例的苯唑西林耐药率对其无影响（p=0.89）。在第二个模型中，金黄色葡萄球菌和表皮葡萄球菌的缓解率相似（p=0.70），黏液（p=0.001）和α-溶血素（p=0.04）的产生是未缓解的独立预测因子。
结论
细菌种类和毒力因子而非抗生素耐药性影响葡萄球菌性腹膜炎的结果。
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