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囊性纤维化患者耐甲氧西林金黄色葡萄球菌感染的发病率及治疗:一项队列研究

Incidence and treatment of methicillin-resistant S. aureus infection in cystic fibrosis patients: a cohort study.

作者信息

Bittencourt Paloma Horejs, Pimentel Carlos Sidney Silva, Bonfim Bianca Sampaio, Marostica Paulo José, Souza Edna Lúcia

机构信息

Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brazil.

Universidade Federal do Rio Grande do Sul, Hospital das Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

出版信息

Braz J Infect Dis. 2017 Jan-Feb;21(1):107-111. doi: 10.1016/j.bjid.2016.09.003. Epub 2016 Oct 15.

Abstract

In Brazil the knowledge about methicillin-resistant Staphylococcus aureus infection in cystic fibrosis patients is scarce. This study aimed to determine the incidence of respiratory tract colonization and the identification rates after a standardized treatment. A retrospective cohort was performed highlighting the history of respiratory colonizations between January 2008 and June 2015. Patients under the age of 21 years with cystic fibrosis confirmed by sweat test or genetic study receiving care at the outpatient clinics of a Teaching Hospital were included. The treatment consisted of trimethoprim/sulfamethoxazole, rifampicin, nasal mupirocin and chlorhexidine 2%. The mean follow-up period was of 22.2 months and those with ≥3 negative cultures were considered free of methicillin-resistant Staphylococcus aureus. Forty-two patients were included. Methicillin-resistant Staphylococcus aureus was identified in six patients. Most patients had methicillin-sensitive S. aureus isolation prior to methicillin-resistant Staphylococcus aureus. Five children used the standardized treatment, none presented side effects. Only one child had a new isolation of methicillin-resistant Staphylococcus aureus during follow-up (after 20 months). The incidence of methicillin-resistant Staphylococcus aureus infection was high and occurred in young patients. The therapeutic regimen was effective, safe and being a good option to treat methicillin-resistant Staphylococcus aureus infection.

摘要

在巴西,关于囊性纤维化患者耐甲氧西林金黄色葡萄球菌感染的知识匮乏。本研究旨在确定呼吸道定植的发生率以及标准化治疗后的识别率。进行了一项回顾性队列研究,重点关注2008年1月至2015年6月期间呼吸道定植的病史。纳入了在一家教学医院门诊接受治疗、年龄在21岁以下且经汗液试验或基因研究确诊为囊性纤维化的患者。治疗包括甲氧苄啶/磺胺甲恶唑、利福平、鼻用莫匹罗星和2%的氯己定。平均随访期为22.2个月,培养结果≥3次阴性的患者被视为无耐甲氧西林金黄色葡萄球菌感染。共纳入42例患者。6例患者被鉴定出耐甲氧西林金黄色葡萄球菌。大多数患者在感染耐甲氧西林金黄色葡萄球菌之前曾分离出对甲氧西林敏感的金黄色葡萄球菌。5名儿童采用了标准化治疗,均未出现副作用。随访期间(20个月后)只有1名儿童再次分离出耐甲氧西林金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌感染的发生率较高,且发生在年轻患者中。该治疗方案有效、安全,是治疗耐甲氧西林金黄色葡萄球菌感染的一个良好选择。

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