Danneels Pierre, Postorino Maria Concetta, Strazzulla Alessio, Belfeki Nabil, Pitch Aurelia, Pourcine Frank, Jochmans Sebastien, Dubée Vincent, Monchi Mehran, Diamantis Sylvain
Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
Can J Infect Dis Med Microbiol. 2020 Sep 9;2020:2093468. doi: 10.1155/2020/2093468. eCollection 2020.
Treatment of (Hi) pneumonia is on concern because resistance to amoxicillin is largely diffused. This study describes the evolution of resistance to amoxicillin and amoxicillin/clavulanic acid (AMC) in Hi isolates and characteristics of patients with Hi severe pneumonia.
A monocentric retrospective observational study including patients from 2008 to 2017 with severe pneumonia hospitalized in ICU. Evolution of amoxicillin and AMC susceptibility was showed. Characteristics of patients with Hi pneumonia were compared to characteristics of patients with (Sp) pneumonia, as reference. Risk factors for amoxicillin resistance in Hi were investigated.
Overall, 113 patients with Hi and 132 with Sp pneumonia were included. The percentages of AMC resistance among Hi strains decreased over the years (from 10% in 2008-2009 to 0% in 2016-2017) while resistance to amoxicillin remained stable at 20%. Also, percentages of Sp resistant strains for amoxicillin decreased over years (from 25% to 3%). Patients with Hi pneumonia experienced higher prevalence of bronchitis (18% vs. 8%, =0.02, chronic obstructive pulmonary disease (43% vs. 30% =0.03), HAP (18% vs. 7%, =0.01, ventilator-associated pneumonia (27% vs. 17%, =0.04, and longer duration of mechanical ventilation (8 days vs. 6 days, =0.04) than patients with Sp pneumonia. Patients with Sp pneumonia had more frequently local complications than patients with Hi pneumonia (17% vs. 7%, =0.03). De-escalation of antibiotics was more frequent in patients with Sp than in patients with Hi (67% vs. 53%, =0.03). No risk factors were associated with amoxicillin resistance among patients with Hi pneumonia.
Amoxicillin resistance was stable over time, but no risk factors were detected. AMC resistance was extremely low, suggesting that AMC could be used for empiric treatment of Hi pneumonia, as well as other molecules, namely, cephalosporins. Patients with Hi pneumonia had more pulmonary comorbidities and severe diseases than patients with Sp pneumonia.
由于对阿莫西林的耐药性广泛传播，因此对流感嗜血杆菌（Hi）肺炎的治疗令人担忧。本研究描述了Hi分离株对阿莫西林和阿莫西林/克拉维酸（AMC）的耐药性演变情况以及Hi重症肺炎患者的特征。
一项单中心回顾性观察研究，纳入了2008年至2017年在重症监护病房住院的重症肺炎患者。展示了阿莫西林和AMC敏感性的演变情况。将Hi肺炎患者的特征与作为对照的肺炎链球菌（Sp）肺炎患者的特征进行了比较。研究了Hi中阿莫西林耐药的危险因素。
总体而言，纳入了113例Hi肺炎患者和132例Sp肺炎患者。多年来Hi菌株中AMC耐药百分比有所下降（从2008 - 2009年的10%降至2016 - 2017年的0%），而对阿莫西林的耐药率保持在20%稳定不变。此外，Sp肺炎对阿莫西林耐药菌株的百分比多年来也有所下降（从25%降至3%）。与Sp肺炎患者相比，Hi肺炎患者支气管炎的患病率更高（18%对8%，P = 0.02）、慢性阻塞性肺疾病（43%对30%，P = 0.03）、医院获得性肺炎（HAP，18%对7%，P = 0.01）、呼吸机相关性肺炎（27%对17%，P = 0.04）以及机械通气时间更长（8天对6天，P = 0.04）。Sp肺炎患者比Hi肺炎患者更常出现局部并发症（17%对7%，P = 0.03）。抗生素降阶梯在Sp肺炎患者中比Hi肺炎患者更频繁（67%对53%，P = 0.03）。Hi肺炎患者中未发现与阿莫西林耐药相关的危险因素。
阿莫西林耐药性随时间保持稳定，但未检测到危险因素。AMC耐药性极低，这表明AMC可用于Hi肺炎的经验性治疗，以及其他分子，即头孢菌素。与Sp肺炎患者相比，Hi肺炎患者有更多的肺部合并症和严重疾病。
