十年间囊性纤维化患者呼吸道标本中重要病原体的患病率及耐药性增加。

Increased Prevalence and Resistance of Important Pathogens Recovered from Respiratory Specimens of Cystic Fibrosis Patients During a Decade.

作者信息

Raidt Lena, Idelevich Evgeny A, Dübbers Angelika, Küster Peter, Drevinek Pavel, Peters Georg, Kahl Barbara C

机构信息

From the *Institute of Medical Microbiology, and †Department of Pediatrics, University Hospital Münster, Münster, Germany; ‡Department of Pediatrics, Clemenshospital Münster, Münster, Germany; and §Department of Medical Microbiology, University Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.

出版信息

Pediatr Infect Dis J. 2015 Jul;34(7):700-5. doi: 10.1097/INF.0000000000000714.

DOI:10.1097/INF.0000000000000714

PMID:25851069

Abstract

BACKGROUND

The study objective was to identify changes of prevalence and resistance of important pathogens in specimens of cystic fibrosis (CF) patients within a decade.

METHODS

Samples of 94 patients, who attended 2 CF centers from 2001 to 2011 were retrospectively analyzed.

RESULTS

Staphylococcus aureus was the most prevalent organism (74.5% in 2011) with an increase of methicillin-resistant S. aureus in patients (0% vs. 9.6%, n = 9). Resistance of S. aureus to gentamicin decreased (41.8% vs. 21%; P < 0.001), whereas resistance to rifampicin and trimethoprim/sulfamethoxazole (P < 0.05) increased significantly with a trend to increased resistance to clindamycin and erythromycin (P = 0.063). Methicillin-resistant S. aureus isolates belonged to 6 spa types (t003, t008, t011, t034, t045, t548). There was a significant increase of Pseudomonas aeruginosa prevalence (63.8% in 2011 vs. 46.8% in 2001, P = 0.019). Resistance of P. aeruginosa increased significantly to imipenem, gentamicin, amikacin, tobramycin, ciprofloxacin and fosfomycin, whereas resistance to piperacillin-tazobactam, meropenem and aztreonam decreased. Significantly fewer Stenotrophomonas maltophilia isolates were susceptible to all the analyzed antibiotics (trimethoprim/sulfamethoxazole, ciprofloxacin and colistin) in 2011 compared with 2001 (13.5% vs. 42.1%; P = 0.023), whereas the resistance to colistin increased significantly (11.1% vs. 62.2%; P < 0.001). Burkholderia cepacia complex and nontuberculous mycobacteria were not detected in 2001 but in 2011 in 7.4% (n = 9) and 7.4% (n = 9) of patients, respectively. B. cepacia complex isolates belonged to 8 multilocus sequence types.

CONCLUSIONS

Our retrospective analysis revealed an increase of important CF-related pathogens, the emergence of new pathogens and a substantial increase of multidrug-resistant CF-specific isolates. Our findings are of importance to clinicians for the alertness of local epidemiology, which may be useful for prevention and treatment strategies.

摘要

背景

本研究的目的是确定十年间囊性纤维化（CF）患者标本中重要病原体的流行率和耐药性变化。

方法

对2001年至2011年在2个CF中心就诊的94例患者的样本进行回顾性分析。

结果

金黄色葡萄球菌是最常见的病原体（2011年为74.5%），耐甲氧西林金黄色葡萄球菌在患者中的比例增加（0%对9.6%，n = 9）。金黄色葡萄球菌对庆大霉素的耐药性降低（41.8%对21%；P < 0.001），而对利福平及甲氧苄啶/磺胺甲恶唑的耐药性显著增加（P < 0.05），对克林霉素和红霉素的耐药性有增加趋势（P = 0.063）。耐甲氧西林金黄色葡萄球菌分离株属于6种spa型（t003、t008、t011、t034、t045、t548）。铜绿假单胞菌的流行率显著增加（2011年为63.8%，2001年为46.8%，P = 0.019）。铜绿假单胞菌对亚胺培南、庆大霉素、阿米卡星、妥布霉素、环丙沙星和磷霉素的耐药性显著增加，而对哌拉西林-他唑巴坦、美罗培南和氨曲南的耐药性降低。与2001年相比，2011年嗜麦芽窄食单胞菌对所有分析抗生素（甲氧苄啶/磺胺甲恶唑、环丙沙星和黏菌素）敏感的分离株明显减少（13.5%对42.1%；P = 0.023），而对黏菌素的耐药性显著增加（11.1%对62.2%；P < 0.001）。洋葱伯克霍尔德菌复合体和非结核分枝杆菌在2001年未检测到，但在2011年分别在7.4%（n = 9）和7.4%（n = 9）的患者中检测到。洋葱伯克霍尔德菌复合体分离株属于8种多位点序列类型。