英国慢性阻塞性肺疾病（COPD）患者中氨苄西林耐药情况。 （原句“Ampicillin resistance in from COPD patients in the UK.”表述不完整，推测补充完整后的翻译）
Ampicillin resistance in from COPD patients in the UK.
作者信息
Maddi Satyanarayana, Kolsum Umme, Jackson Sarah, Barraclough Richard, Maschera Barbara, Simpson Karen D, Pascal Thierry G, Durviaux Serge, Hessel Edith M, Singh Dave
机构信息
Division of Infection, Immunity and Respiratory Medicine, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester.
Department of Respiratory Medicine, University Hospital of South Manchester Foundation Trust, Manchester.
出版信息
Int J Chron Obstruct Pulmon Dis. 2017 May 22;12:1507-1518. doi: 10.2147/COPD.S135338. eCollection 2017.
BACKGROUND
is commonly isolated from the airways of COPD patients. Antibiotic treatment may cause the emergence of resistant strains, particularly ampicillin-resistant strains, including β-lactamase-negative ampicillin resistance (BLNAR) strains. Genetic identification using sequencing is the optimum method for identifying mutations within BLNAR strains. The prevalence of BLNAR in COPD patients during the stable state has not been reported. We investigated the antibiotic resistance patterns of present in the sputum of stable COPD patients, focusing on ampicillin resistance; the prevalence of enzyme and non-enzyme-mediated ampicillin resistance was determined. A subset of patients was followed up longitudinally to study strain switching and antibiotic sensitivity changes.
PATIENTS AND METHODS
Sputum sampling was performed in 61 COPD patients, with 42 samples obtained at baseline; was detected by polymerase chain reaction in 28 samples. In all, 45 patients completed the follow-up for 2 years; 24 isolates were obtained.
RESULTS
Disk diffusion showed the highest antibiotic resistance in the penicillin antibiotic group (eg, 67% for ampicillin) and macrolides (eg, 46% for erythromycin), whereas all isolates were susceptible to quinolones. Of the 16 isolates resistant to ampicillin, 9 (56%) were β-lactamase positive. The β-lactamase-negative isolates were further investigated; none of these fulfilled the phenotypic BLNAR classification criteria of ampicillin minimum inhibitory concentration >1 µg/mL, and only one demonstrated an mutation. Frequent strain switching was confirmed using multilocus sequence typing and was associated with changes in the antibiotic sensitivity pattern.
CONCLUSION
We observed an overidentification of ampicillin resistance by disk diffusion. The majority of ampicillin resistance was due to enzyme production. strain changes during the stable state may be associated with a change in antibiotic sensitivity; this has implications for empirical antibiotic prescribing.
背景
常从慢性阻塞性肺疾病（COPD）患者气道中分离得到。抗生素治疗可能导致耐药菌株出现，尤其是耐氨苄西林菌株，包括β-内酰胺酶阴性氨苄西林耐药（BLNAR）菌株。使用测序进行基因鉴定是识别BLNAR菌株内突变的最佳方法。稳定期COPD患者中BLNAR的患病率尚未见报道。我们调查了稳定期COPD患者痰液中存在的抗生素耐药模式，重点关注氨苄西林耐药情况；确定了酶介导和非酶介导氨苄西林耐药的患病率。对一部分患者进行纵向随访，以研究菌株转换和抗生素敏感性变化。
患者和方法
对61例COPD患者进行痰液采样，基线时获取42份样本；28份样本通过聚合酶链反应检测到。总共45例患者完成了2年的随访；获得24株分离株。
结果
纸片扩散法显示青霉素类抗生素组（如氨苄西林耐药率为67%）和大环内酯类（如红霉素耐药率为46%）抗生素耐药性最高，而所有分离株对喹诺酮类均敏感。在16株耐氨苄西林的分离株中，9株（占56%）β-内酰胺酶阳性。对β-内酰胺酶阴性分离株进行了进一步研究；这些分离株均未符合氨苄西林最低抑菌浓度>1μg/mL的BLNAR表型分类标准，仅1株显示有突变。使用多位点序列分型证实了频繁的菌株转换，且与抗生素敏感性模式的变化有关。
结论
我们观察到纸片扩散法对氨苄西林耐药的过度鉴定。大多数氨苄西林耐药是由酶产生所致。稳定期菌株变化可能与抗生素敏感性改变有关；这对经验性抗生素处方具有启示意义。
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