左氧氟沙星耐药肺炎链球菌引起的侵袭性感染的危险因素和临床意义。
Risk factors and clinical significance of invasive infections caused by levofloxacin-resistant Streptococcus pneumoniae.
机构信息
Department of Medicine, The Services of Clinical Microbiology and Infectious Diseases, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
出版信息
Infection. 2013 Oct;41(5):935-9. doi: 10.1007/s15010-013-0481-4. Epub 2013 May 25.
PURPOSE
Fluoroquinolones are recommended for the treatment of pneumonia. The recognition of risk factors for invasive levofloxacin-resistant Streptococcus pneumoniae is important for the design of treatment.
METHODS
A retrospective review of cases of invasive pneumococcal infections in adults was undertaken. Epidemiologic data, predisposing factors, clinical variables, and outcome were recorded from previously established protocols. Antimicrobial susceptibility was determined by disk diffusion and the Etest method. Serotyping was performed by latex agglutination and Quellung reaction.
RESULTS
Twenty patients with infection caused by levofloxacin-resistant pneumococci [minimum inhibitory concentration (MIC) ≥2 μg/ml] were compared with 102 patients harboring levofloxacin-susceptible strains; 80% of levofloxacin-resistant pneumococci were resistant to ≥3 antibiotics but susceptible to penicillin. Most levofloxacin-resistant strains (80%) belonged to serotype 8. In comparison, only 8% of levofloxacin-susceptible pneumococci belonged to serotype 8. In the multivariate analysis, residence in public shelters [odds ratio (OR) 26.13; p 0.002], previous hospitalization (OR 61.77; p < 0.001), human immunodeficiency virus (HIV) infection (OR 28.14; p = 0.009), and heavy smoking (OR 14.41; p = 0.016) were associated with an increased risk of infection by levofloxacin-resistant pneumococci. Mortality caused by levofloxacin-resistant and levofloxacin-susceptible pneumococci was 35 and 14%, respectively. Among HIV-positive individuals infected with levofloxacin-resistant pneumococci 44% died, but only 12.5% of HIV-positive patients with levofloxacin-susceptible strains died.
CONCLUSIONS
We observed the emergence of serotype 8 as the main cause of invasive disease caused by levofloxacin-resistant S. pneumoniae. HIV-positive patients seem to be prone to infection caused by multidrug-resistant serotype 8 and have a high mortality rate.
目的
氟喹诺酮类药物被推荐用于肺炎的治疗。识别侵袭性左氧氟沙星耐药肺炎链球菌的危险因素对于治疗方案的设计非常重要。
方法
对成人侵袭性肺炎球菌感染病例进行回顾性研究。根据先前建立的方案记录流行病学数据、易患因素、临床变量和结局。通过纸片扩散法和 Etest 法测定抗菌药物敏感性。通过乳胶凝集和 Quellung 反应进行血清分型。
结果
将 20 例感染左氧氟沙星耐药肺炎球菌（最低抑菌浓度 [MIC]≥2μg/ml）的患者与 102 例携带左氧氟沙星敏感菌株的患者进行比较；80%的左氧氟沙星耐药肺炎球菌对≥3 种抗生素耐药，但对青霉素敏感。大多数左氧氟沙星耐药菌株（80%）属于血清型 8。相比之下，仅 8%的左氧氟沙星敏感肺炎球菌属于血清型 8。多变量分析显示，居住在公共收容所（比值比 [OR]26.13；p<0.002）、既往住院（OR 61.77；p<0.001）、人类免疫缺陷病毒（HIV）感染（OR 28.14；p=0.009）和大量吸烟（OR 14.41；p=0.016）与感染左氧氟沙星耐药肺炎球菌的风险增加相关。由左氧氟沙星耐药和左氧氟沙星敏感肺炎球菌引起的死亡率分别为 35%和 14%。在感染左氧氟沙星耐药肺炎球菌的 HIV 阳性患者中，44%死亡，但感染左氧氟沙星敏感菌株的 HIV 阳性患者中，仅 12.5%死亡。
结论
我们观察到血清型 8 成为左氧氟沙星耐药肺炎链球菌引起侵袭性疾病的主要原因。HIV 阳性患者似乎容易感染多药耐药血清型 8，死亡率较高。
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