Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome 00168, Italy.
Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC Pneumologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Largo A. Gemelli 8, Rome 00168, Italy.
QJM. 2020 Oct 1;113(10):726-730. doi: 10.1093/qjmed/hcaa120.
Stenotrophomonas maltophilia is a bacteria whose role in patients with cystic fibrosis (CF) bronchiectasis has been previously studied; little is known about its role in non-CF bronchiectasis.
Aim of our study is to investigate the risk factors for S. maltophilia acquisition and its clinical impact on bronchiectasis patients. A retrospective observational cohort study enrolling patients attending the Bronchiectasis Clinic at the Royal Infirmary of Edinburgh, Scotland, UK. A total of 167 bronchiectasis patients undergoing intravenous (IV) antibiotic therapy were selected and divided according to single or chronic S. maltophilia isolation in sputum. The risk factors and prognostic impact were studied.
Single isolation was independently associated with lower baseline % predicted forced expiratory volume in 1 s [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.970-1.044; P = 0.025] and with less radiological involvement (OR 0.379; 95% CI 0.175-0.819; P = 0.01). Chronic isolation was associated with the number of IV antibiotic courses in the year before and after the first isolation (OR 1.2; 95% CI 1.053-1.398; P = 0.007) and with the absence of Pseudomonas aeruginosa colonization (OR 0.207; 95% CI 0.056-0.764; P = 0.02). In the chronic isolation group, there were more exacerbations and more need of IV antibiotics in the year after the first isolation.
Poor lung function is the main independent risk factor for single isolation of S. maltophilia. For chronic colonization, the main independent risk factor is the number of IV antibiotic courses and the absence of P. aeruginosa chronic colonization. Only when chronically present, S. maltophilia had a clinical impact with more exacerbations.
嗜麦芽寡养单胞菌是一种细菌，其在囊性纤维化（CF）支气管扩张患者中的作用已被先前研究过；但其在非 CF 支气管扩张中的作用知之甚少。
我们的研究目的是调查嗜麦芽寡养单胞菌获得的危险因素及其对支气管扩张症患者的临床影响。这是一项在苏格兰爱丁堡皇家医院支气管扩张症诊所进行的回顾性观察队列研究。共选择了 167 名接受静脉（IV）抗生素治疗的支气管扩张症患者，并根据痰中单一或慢性嗜麦芽寡养单胞菌分离情况进行分组。研究了危险因素和预后影响。
单一分离独立与较低的基线预测 1 秒用力呼气量的百分比相关[比值比（OR）0.98；95%置信区间（CI）0.970-1.044；P=0.025]和较少的放射学受累（OR 0.379；95%CI 0.175-0.819；P=0.01）。慢性分离与首次分离前后一年 IV 抗生素疗程数有关（OR 1.2；95%CI 1.053-1.398；P=0.007），与无铜绿假单胞菌定植有关（OR 0.207；95%CI 0.056-0.764；P=0.02）。在慢性分离组中，首次分离后一年的恶化次数和 IV 抗生素的需求更多。
单一致病的主要独立危险因素是肺功能差。对于慢性定植，主要的独立危险因素是 IV 抗生素疗程数和缺乏铜绿假单胞菌慢性定植。只有当慢性存在时，嗜麦芽寡养单胞菌才会导致更多的恶化。
