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在使用快速诊断检测的 SARS-CoV-2 阳性患者中观察到的合并感染。

Co-infections observed in SARS-CoV-2 positive patients using a rapid diagnostic test.

机构信息

Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.

Microbiology and Virology Lab, Tor Vergata University Hospital, V.le Oxford, 81 00133, Rome, Italy.

出版信息

Sci Rep. 2021 Aug 11;11(1):16355. doi: 10.1038/s41598-021-95772-3.

Abstract

Rapid diagnostic tests are tools of paramount impact both for improving patient care and in antimicrobial management programs. Particularly in the case of respiratory infections, it is of great importance to quickly confirm/exclude the involvement of pathogens, be they bacteria or viruses, while obtaining information about the presence/absence of a genetic target of resistance to modulate antibiotic therapy. In this paper, we present our experiences with the use of the Biofire® FilmArray® Pneumonia Panel Plus (FAPP; bioMérieux; Marcy l'Etoile, France) to assess coinfection in COVID-19 patients. A total of 152 respiratory samples from consecutive patients were examined, and 93 (61%) were found to be FAPP positive, with the detection of bacteria and/or viruses. The patients were 93 males and 59 females with an average age of 65 years who were admitted to our hospital due to moderate/severe acute respiratory symptoms. Among the positive samples were 52 from sputum (SPU) and 41 from bronchoalveolar lavage (BAL). The most representative species was S. aureus (most isolates were mecA positive; 30/44, 62%), followed by gram-negative pathogens such as P. aeruginosa, K. pneumoniae, and A. baumannii. Evidence of a virus was rare. Cultures performed from BAL and SPU samples gave poor results. Most of the discrepant negative cultures were those in which FAPP detected pathogens with a microbial count ≤ 10 CFU/mL. H. influenzae was one of the most common pathogens lost by the conventional method. Despite the potential limitations of FAPP, which detects a defined number of pathogens, its advantages of rapid detection combined with predictive information regarding the antimicrobial resistance of pathogens through the detection of some relevant markers of resistance could be very useful for establishing empirical targeted therapy for the treatment of patients with respiratory failure. In the COVID era, we understand the importance of using antibiotics wisely to curb the phenomenon of antibiotic resistance.

摘要

快速诊断检测对于改善患者护理和抗菌管理计划都具有至关重要的影响。特别是在呼吸道感染的情况下,快速确认/排除病原体(无论是细菌还是病毒)的参与,并获得有关抗生素治疗的耐药性遗传靶标存在/缺失的信息,这一点非常重要。在本文中,我们介绍了使用 Biofire® FilmArray® Pneumonia Panel Plus (FAPP; bioMérieux; Marcy l'Etoile, France) 评估 COVID-19 患者合并感染的经验。共检查了 152 例连续患者的呼吸道样本,其中 93 例(61%)FAPP 检测结果为阳性,检测到细菌和/或病毒。这些患者为 93 名男性和 59 名女性,平均年龄为 65 岁,因中度/重度急性呼吸道症状而入住我院。阳性样本中,52 例来自痰液(SPU),41 例来自支气管肺泡灌洗(BAL)。最具代表性的物种是金黄色葡萄球菌(大多数分离株 mecA 阳性;30/44,62%),其次是革兰氏阴性病原体,如铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌。病毒证据很少。BAL 和 SPU 样本的培养结果不佳。大多数不一致的阴性培养物是 FAPP 检测到微生物计数≤10 CFU/mL 的病原体的培养物。流感嗜血杆菌是常规方法丢失的最常见病原体之一。尽管 FAPP 存在检测定义数量的病原体的潜在局限性,但它具有快速检测的优势,并通过检测一些相关的耐药标记物提供有关病原体耐药性的预测信息,这对于为呼吸衰竭患者建立经验性靶向治疗非常有用。在 COVID 时代,我们了解明智使用抗生素以遏制抗生素耐药现象的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d36e/8357960/92641fe5e098/41598_2021_95772_Fig1_HTML.jpg

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