Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
Clin Microbiol Infect. 2014 May;20(5):O285-91. doi: 10.1111/1469-0691.12406. Epub 2013 Nov 4.
Staphylococcus aureus is the most commonly isolated pathogen in respiratory tract secretions from young patients with cystic fibrosis (CF), and several treatment strategies are used to control the infection. However, it is not known whether intensified treatment with antimicrobial agents causes eradication of S. aureus clones. We retrospectively determined the impact of intravenous (IV) antimicrobial agents on the suppression and eradication of S. aureus clones. One thousand and sixty-one S. aureus isolates cultured from 2526 samples from 130 CF patients during a 2-year study period were subjected to spa typing. Intervals between positive samples and the occurrence of clone replacements were calculated in relation to courses of IV antimicrobial agents. Of 65 patients chronically infected with S. aureus, 37 received 139 courses of IV antimicrobial agents with activity against S. aureus (mean duration, 15 days; range, 6-31 days). Administration of IV antibiotics increased the time to the next sample with growth of S. aureus: the mean interval between two positive samples was 68 days if IV treatment had been administered, in contrast to 49 days if no IV treatment had been administered (p 0.003). When S. aureus recurred in sputum after IV treatment, the isolate belonged to a different clone in 33 of 114 (29%) intervals, in comparison with 68 of 232 (29%) intervals where IV treatment had not been prescribed (OR 0.98, 95% CI 0.60-1.61). In conclusion, we show that 2 weeks of IV antimicrobial treatment can significantly suppress chronic staphylococcal infection in CF, but is not associated with the eradication of persistent bacterial clones.
金黄色葡萄球菌是囊性纤维化（CF）年轻患者呼吸道分泌物中最常分离到的病原体，有几种治疗策略用于控制感染。然而，目前尚不清楚强化抗菌药物治疗是否会导致金黄色葡萄球菌克隆的清除。我们回顾性地确定了静脉（IV）抗菌药物对金黄色葡萄球菌克隆的抑制和清除的影响。在为期 2 年的研究期间，从 130 例 CF 患者的 2526 份样本中培养了 1061 株金黄色葡萄球菌分离株，并进行了 spa 分型。计算了阳性样本与克隆替换之间的间隔与 IV 抗菌药物疗程的关系。在 65 例慢性金黄色葡萄球菌感染的患者中，有 37 例接受了 139 例针对金黄色葡萄球菌的 IV 抗菌药物治疗（平均疗程为 15 天，范围为 6-31 天）。IV 抗生素的使用增加了下一个金黄色葡萄球菌生长样本的时间：如果给予 IV 治疗，两个阳性样本之间的平均间隔为 68 天，而如果未给予 IV 治疗，则为 49 天（p<0.003）。当 IV 治疗后痰液中的金黄色葡萄球菌再次出现时，在 114 个间隔中有 33 个（29%）的分离株属于不同的克隆，而在未开具 IV 治疗的 232 个间隔中有 68 个（29%）属于不同的克隆（OR 0.98，95%CI 0.60-1.61）。总之，我们表明 2 周的 IV 抗菌药物治疗可以显著抑制 CF 中的慢性葡萄球菌感染，但与持续细菌克隆的清除无关。
