Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Front Cell Infect Microbiol. 2022 Sep 16;12:964539. doi: 10.3389/fcimb.2022.964539. eCollection 2022.
In the past decades, due to the high prevalence of the antibiotic-resistant isolates of , it has emerged as one of the most troublesome pathogens threatening the global healthcare system. Furthermore, this pathogen has the ability to form biofilms, which is another effective mechanism by which it survives in the presence of antibiotics. However, the clinical impact of biofilm-forming isolates on patients with bacteremia is largely unknown. This retrospective study was conducted at five medical centers in Taiwan over a 9-year period. A total of 252 and 459 patients with bacteremia caused by biofilm- and non-biofilm-forming isolates of , respectively, were enrolled. The clinical demographics, antimicrobial susceptibility, biofilm-forming ability, and patient clinical outcomes were analyzed. The biofilm-forming ability of the isolates was assessed using a microtiter plate assay. Multivariate analysis revealed the higher APACHE II score, shock status, lack of appropriate antimicrobial therapy, and carbapenem resistance of the infected strain were independent risk factors of 28-day mortality in the patients with bacteremia. However, there was no significant difference between the 28-day survival and non-survival groups, in terms of the biofilm forming ability. Compared to the patients infected with non-biofilm-forming isolates, those infected with biofilm-forming isolates had a lower in-hospital mortality rate. Patients with either congestive heart failure, underlying hematological malignancy, or chemotherapy recipients were more likely to become infected with the biofilm-forming isolates. Multivariate analysis showed congestive heart failure was an independent risk factor of infection with biofilm-forming isolates, while those with arterial lines tended to be infected with non-biofilm-forming isolates. There were no significant differences in the sources of infection between the biofilm-forming and non-biofilm-forming isolate groups. Carbapenem susceptibility was also similar between these groups. In conclusion, the patients infected with the biofilm-forming isolates of the exhibited different clinical features than those infected with non-biofilm-forming isolates. The biofilm-forming ability of may also influence the antibiotic susceptibility of its isolates. However, it was not an independent risk factor for a 28-day mortality in the patients with bacteremia.
在过去的几十年中，由于抗生素耐药分离株的高流行率， 已成为威胁全球医疗保健系统的最棘手病原体之一。此外，这种病原体能够形成生物膜，这是其在存在抗生素的情况下存活的另一种有效机制。然而，生物膜形成的 分离株对菌血症患者的临床影响在很大程度上尚不清楚。这项回顾性研究在台湾的五家医疗中心进行，历时 9 年。共纳入了 252 例和 459 例分别由生物膜形成和非生物膜形成的 引起的菌血症患者。分析了临床人口统计学，抗生素敏感性，生物膜形成能力和患者临床结局。使用微量滴定板测定法评估分离株的生物膜形成能力。多变量分析显示，较高的 APACHE II 评分，休克状态，缺乏适当的抗菌治疗以及感染株的碳青霉烯耐药是菌血症患者 28 天死亡率的独立危险因素。然而，在生物膜形成能力方面，28 天存活组与非存活组之间没有显着差异。与感染非生物膜形成分离株的患者相比，感染生物膜形成分离株的患者的院内死亡率较低。患有充血性心力衰竭，潜在血液恶性肿瘤或化疗接受者的患者更有可能感染生物膜形成的分离株。多变量分析显示，充血性心力衰竭是感染生物膜形成分离株的独立危险因素，而动脉线患者更倾向于感染非生物膜形成分离株。生物膜形成和非生物膜形成分离株组之间的感染源没有显着差异。这些组之间的碳青霉烯敏感性也相似。总之，感染生物膜形成的 分离株的患者表现出与感染非生物膜形成分离株的患者不同的临床特征。 生物膜形成能力也可能影响其分离株的抗生素敏感性。但是，它不是菌血症患者 28 天死亡率的独立危险因素。
