Kraef Christian, Alabi Abraham S, Peters Georg, Becker Karsten, Kremsner Peter G, Rossatanga Elie G, Mellmann Alexander, Grobusch Martin P, Zanger Philipp, Schaumburg Frieder
Institute of Medical Microbiology, University Hospital Münster Münster, Germany ; Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon.
Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital Lambaréné, Gabon ; Institut für Tropenmedizin, Eberhard Karls Universität, Deutsches Zentrum für Infektionsforschung Tübingen, Germany.
Front Microbiol. 2015 Feb 5;6:60. doi: 10.3389/fmicb.2015.00060. eCollection 2015.
Patients infected with the human immunodeficiency virus (HIV) are frequently exposed to antimicrobial agents. This might have an impact on the resistance profile, genetic background and virulence factors of colonizing Staphylococcus aureus. Sub-Saharan Africa is considered to be endemic for Panton-Valentine leukocidin (PVL) positive S. aureus which can be associated with skin and soft tissue infections (SSTI). We compared S. aureus from nasal and pharyngeal swabs from HIV patients (n = 141) and healthy controls (n = 206) in Gabon in 2013, and analyzed determinants of colonization with PVL positive isolates in a cross-sectional study. S. aureus isolates were screened for the presence of selected virulence factors (incl. PVL) and were subjected to antimicrobial susceptibility testing and genotyping. In HIV patients, S. aureus was more frequently detected (36.9 vs. 31.6%) and the isolates were more frequently PVL positive than in healthy controls (42.1 vs. 23.2%). The presence of PVL was associated with cotrimoxazole resistance (OR = 25.1, p < 0.001) and the use of cotrimoxazole was a risk factor for colonization with PVL positive isolates (OR = 2.5, p = 0.06). PVL positive isolates were associated with the multilocus sequence types ST15 (OR = 5.6, p < 0.001) and ST152 (OR = 62.1, p < 0.001). Participants colonized with PVL positive isolates reported more frequently SSTI in the past compared to carriers of PVL negative isolates (OR = 2.7, p = 0.01). In conclusion, the novelty of our study is that cotrimoxazole might increase the risk of SSTI in regions where cotrimoxazole resistance is high and associated with PVL. This finding needs to be confirmed in prospective studies.
感染人类免疫缺陷病毒（HIV）的患者经常接触抗菌药物。这可能会对定植的金黄色葡萄球菌的耐药性、基因背景和毒力因子产生影响。撒哈拉以南非洲被认为是杀白细胞素（PVL）阳性金黄色葡萄球菌的流行地区，该菌可引起皮肤和软组织感染（SSTI）。2013年，我们比较了加蓬HIV患者（n = 141）和健康对照者（n = 206）鼻拭子和咽拭子中的金黄色葡萄球菌，并在一项横断面研究中分析了PVL阳性分离株定植的决定因素。对金黄色葡萄球菌分离株进行了选定毒力因子（包括PVL）的检测，并进行了抗菌药物敏感性试验和基因分型。与健康对照者相比，HIV患者中金黄色葡萄球菌的检出率更高（36.9%对31.6%），分离株PVL阳性的频率也更高（42.1%对23.2%）。PVL的存在与复方新诺明耐药相关（比值比=25.1，p<0.001），使用复方新诺明是PVL阳性分离株定植的危险因素（比值比=2.5，p = 0.06）。PVL阳性分离株与多位点序列类型ST15（比值比=5.6，p<0.001）和ST152（比值比=62.1，p<0.001）相关。与PVL阴性分离株携带者相比，PVL阳性分离株定植的参与者过去报告SSTI的频率更高（比值比=2.7，p = 0.01）。总之，我们研究的新颖之处在于，在复方新诺明耐药率高且与PVL相关的地区，复方新诺明可能会增加SSTI的风险。这一发现需要在前瞻性研究中得到证实。
