导管相关尿路感染与顽固性生物膜产生菌
Catheter-Associated Urinary Tract Infection and Obstinate Biofilm Producers.
作者信息
Maharjan Govinda, Khadka Priyatam, Siddhi Shilpakar Gomik, Chapagain Ganesh, Dhungana Guna Raj
机构信息
Janamaitri Foundation Institute of Health Science (JFIHS), Kathmandu, Nepal.
Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
出版信息
Can J Infect Dis Med Microbiol. 2018 Aug 26;2018:7624857. doi: 10.1155/2018/7624857. eCollection 2018.
BACKGROUND
Biofilms, or colonies of uropathogen growing on the surface of indwelling medical devices, can inflict obstinate or recurring infection, thought-provoking antimicrobial therapy.
METHODS
This prospective analysis included 105 urine samples from catheterized patients receiving intensive care. Ensuing phenotypic identification, antibiotic sensitivity test was performed by modified Kirby-Bauer disc diffusion method following CLSI guidelines; MDR isolates were identified according to the combined guidelines of the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). Biofilm-forming uropathogens were detected by the tissue culture plate (TCA) method.
RESULTS
The predominant uropathogen in catheter-associated UTIs (CAUTIs) was 57%, followed by 15%, 12%, 8%, spp. 3%, , spp., and 1.5%, of which 46% isolates were biofilm producers. Prime biofilm producers were 33%, followed by 30%, 20%, 10%, , and 3.33%. Multidrug resistance associated with biofilm producers were greater than biofilm nonproducers. The Gram-negative biofilm producers found 96.15%, 80.76%, 73.07%, 53.84%, 53.84%, 46.15%, 19.23%, and 11.5% resistant to amoxyclave, ceftazidime, tetracycline, gentamicin, meropenem, nitrofurantoin, amikacin, imipenem, and fosfomycin, respectively. Gram-positive biofilm producers, however, were found 100% resistant to tetracycline, cloxacillin, and amoxyclave: 66.67% resistant to ampicillin while 33.33% resistant to gentamicin, ciprofloxacin, and nitrofurantoin.
CONCLUSION
High antimicrobial resistance was observed in biofilm producers than non-biofilm producers. Of recommended antimicrobial therapies for CAUTIs, ampicillin and amoxicillin-clavulanate were the least active antibiotics, whereas piperacillin/tazobactam and imipenem were found as the most effectual for gram-negative biofilm producer. Likewise, amoxicillin-clavulanate and tetracycline were the least active antibiotics, whereas vancomycin, fosfomycin, piperacillin-tazobactam, and meropenem were found as the most effective antibiotic for Gram-positive biofilm producer. In the limelight, the activity fosfomycin was commendable against both Gram-positive and Gram-negative biofilm producers.
背景
生物膜，即在留置医疗设备表面生长的尿路病原体菌落，可导致顽固性或复发性感染，引发对抗菌治疗的思考。
方法
这项前瞻性分析纳入了105例接受重症监护的导尿患者的尿液样本。进行表型鉴定后，按照CLSI指南采用改良的 Kirby-Bauer 纸片扩散法进行抗生素敏感性试验；根据欧洲疾病预防控制中心（ECDC）和美国疾病控制与预防中心（CDC）的联合指南鉴定多重耐药菌株。采用组织培养板（TCA）法检测形成生物膜的尿路病原体。
结果
导管相关尿路感染（CAUTIs）中占主导地位的尿路病原体为 57%，其次是 15%、12%、8%、 spp. 3%、 、 spp. 以及 1.5%，其中 46% 的分离株是生物膜产生菌。主要的生物膜产生菌为 33%，其次是 30%、20%、10%、 以及 3.33%。与生物膜产生菌相关的多重耐药性高于非生物膜产生菌。发现革兰氏阴性生物膜产生菌对阿莫西林克拉维酸、头孢他啶、四环素、庆大霉素、美罗培南、呋喃妥因、阿米卡星、亚胺培南和磷霉素的耐药率分别为 96.15%、80.76%、73.07%、53.84%、53.84%、46.15%、19.23% 和 11.5%。然而，革兰氏阳性生物膜产生菌对四环素、氯唑西林和阿莫西林克拉维酸的耐药率为 100%；对氨苄西林的耐药率为 66.67%，而对庆大霉素、环丙沙星和呋喃妥因的耐药率为 33.33%。
结论
观察到生物膜产生菌的抗菌耐药性高于非生物膜产生菌。在推荐的 CAUTIs 抗菌治疗中，氨苄西林和阿莫西林克拉维酸是活性最低的抗生素，而哌拉西林/他唑巴坦和亚胺培南对革兰氏阴性生物膜产生菌最为有效。同样，阿莫西林克拉维酸和四环素是活性最低的抗生素，而万古霉素、磷霉素、哌拉西林 - 他唑巴坦和美罗培南是对革兰氏阳性生物膜产生菌最有效的抗生素。值得注意的是，磷霉素对革兰氏阳性和革兰氏阴性生物膜产生菌的活性都值得称赞。
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