Majoni Sandawana William, Hughes Jaquelyne T, Heron Bianca, Currie Bart J
Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Casuarina, Darwin, Northern Territory, Australia.
Northern Territory Medical Program, Flinders University School of Medicine, Tiwi, Darwin, Northern Territory, Australia.
Kidney Int Rep. 2017 Sep 20;3(1):160-167. doi: 10.1016/j.ekir.2017.09.005. eCollection 2018 Jan.
Melioidosis causes sepsis and death in the Top End of Northern Australia during the monsoonal wet season. Dialysis-dependent adults suffer higher melioidosis rates compared to low rates among renal transplant patients who routinely receive trimethoprim+sulfamethoxazole prophylaxis.
We performed a prospective interventional study to determine the efficacy and safety of daily trimethoprim+sulfamethoxazole prophylaxis in hemodialysis patients during the wet season, from 1 November 2014 to 30 April 2015. Hemodialysis (for ≥ 3 months) patients ≥ 18 years of age were offered treatment. A total of 269 patients on hemodialysis were eligible. Eight of the 269 patients (3%) were excluded from the analysis for being on melioidosis treatment. In all, 169 of 261 patients (64.8%) received the prophylaxis, and 92 of 261 patients (35.2%) did not, because of allergy history (n = 10), remoteness and logistical reasons (n = 60), poor dialysis attendance (n = 11), and refusal (n = 11). We monitored for clinical side effects 3 times weekly and neutropenia, thrombocytopenia, and liver function monthly throughout treatment and for 2 months posttreatment.
In all, 169 of 261 patients (64.8%) received the prophylaxis. There was no age (years) difference by group (prophylaxis vs. nonprophylaxis, 54.7 [11.3] vs. 54.3 [11.2] [ = 0.751]). Sixteen of 261 patients (6%) had melioidosis. The event frequency was 0% (0/169, prophylaxis, vs. 17.4% [16/92, nonprophylaxis], < 0.001). Higher thrombocytopenia and neutropenia rates were noted in the prophylaxis group. These did not warrant treatment stoppage. There was no difference in liver function. Three patients (1.8%) withdrew from the treatment because of side effects.
Daily dosing was effective and safe. Posthemodialysis dosing in the subsequent seasons was effective and safer. We recommend this approach in melioidosis-prevalent regions.
类鼻疽病在澳大利亚北部顶端的季风雨季会引发败血症和死亡。依赖透析的成年人患类鼻疽病的几率更高，而常规接受甲氧苄啶+磺胺甲恶唑预防治疗的肾移植患者患病率较低。
我们进行了一项前瞻性干预研究，以确定2014年11月1日至2015年4月30日雨季期间，每日服用甲氧苄啶+磺胺甲恶唑对血液透析患者进行预防治疗的疗效和安全性。研究为18岁及以上接受血液透析（≥3个月）的患者提供治疗。共有269名血液透析患者符合条件。269名患者中有8名（3%）因正在接受类鼻疽病治疗而被排除在分析之外。在261名患者中，共有169名（64.8%）接受了预防治疗，92名（35.2%）未接受，原因包括过敏史（n = 10）、地处偏远及后勤原因（n = 60）、透析出勤率低（n = 11）和拒绝（n = 11）。在整个治疗期间及治疗后2个月，我们每周监测3次临床副作用，每月监测中性粒细胞减少、血小板减少和肝功能。
261名患者中，共有169名（64.8%）接受了预防治疗。两组之间的年龄（岁）无差异（预防组与非预防组，54.7 [11.3] 对54.3 [11.2] [P = 0.751]）。261名患者中有16名（6%）患类鼻疽病。发病频率为0%（0/169，预防组，对17.4% [16/92，非预防组]，P < 0.001）。预防组的血小板减少和中性粒细胞减少率较高。但这些情况无需停药。肝功能无差异。3名患者（1.8%）因副作用退出治疗。
每日给药有效且安全。在随后的季节中，透析后给药有效且更安全。我们建议在类鼻疽病流行地区采用这种方法。
