Pentland Daniel R, Stevens Sarah, Williams Leila, Baker Mark, McCall Carolyn, Makarovaite Viktorija, Balfour Alistair, Mühlschlegel Friedrich A, Gourlay Campbell W
Kent Fungal Group, School of Biosciences, University of Kent, Kent, United Kingdom.
East Kent Hospitals, University NHS Foundation Trust, Kent, United Kingdom.
Front Microbiol. 2020 May 20;11:975. doi: 10.3389/fmicb.2020.00975. eCollection 2020.
Indwelling silicone valves called voice prostheses (VPs) are the gold standard for speech rehabilitation in patients with laryngeal cancer following total laryngectomy. Reported VP lifespans amongst these patients are highly variable but when devices fail patients experience loss of voice and an increase risk of chest infection. Early failure of VP is a current clinical concern that is associated with regular hospital visits, reduced quality of life and associated medical cost. Poly-microbial biofilms comprised of both bacterial and fungal microorganisms readily colonize VPs and are linked to loss of device performance and its early failure in addition to providing a reservoir for potential infection. Our detailed analysis of poly-microbial biofilm composition on 159 early failing VPs from 48 total laryngectomy patients confirmed as the predominant fungal species and as the most common bacterial colonizer within our patient cohort. Using a combination of microbiological analysis, patient data and a high-throughput antifungal test assay mimicking conditions we established an evidence based precision antifungal treatment approach to VP management. Our approach has allowed us to implement a personalized VP management pathway, which increases device lifespan by an average of 270%. Our study represents a significant step forward in both our understanding of the cause of VP failure and a new effective treatment pathway that offers tangible benefit to patients.
被称为语音假体（VPs）的植入式硅胶瓣膜是全喉切除术后喉癌患者语音康复的金标准。据报道，这些患者中语音假体的使用寿命差异很大，但当设备出现故障时，患者会失去声音，胸部感染风险增加。语音假体的早期故障是当前临床关注的问题，这与定期就医、生活质量下降以及相关医疗费用有关。由细菌和真菌微生物组成的多微生物生物膜很容易在语音假体上定植，除了为潜在感染提供一个储存库外，还与设备性能丧失及其早期故障有关。我们对48例全喉切除患者的159个早期失效语音假体上的多微生物生物膜组成进行了详细分析，证实 为主要真菌种类， 为我们患者队列中最常见的细菌定植菌。通过结合微生物分析、患者数据和模拟 条件的高通量抗真菌测试分析，我们建立了一种基于证据的精确抗真菌治疗方法来管理语音假体。我们的方法使我们能够实施个性化的语音假体管理途径，使设备使用寿命平均延长270%。我们的研究在我们对语音假体故障原因的理解以及为患者带来切实益处的新有效治疗途径方面都迈出了重要一步。
