慢性肾脏病和终末期肾病患者慢性鼻-鼻窦炎的微生物分析

Microbial Analysis in Chronic Rhinosinusitis Patients with Chronic Kidney Disease and End-Stage Renal Disease.

作者信息

Lo Sheng-Wei, Ding Meng-Chang, Tsai Yao-Te, Tsai Ming-Shao, Liu Chia-Yen, Hsu Cheng-Ming, Yang Yao-Hsu, Chang Geng-He

机构信息

Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.

Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Laryngoscope. 2024 Aug;134(8):3499-3507. doi: 10.1002/lary.31389. Epub 2024 Mar 9.

DOI:10.1002/lary.31389

PMID:38459950

Abstract

INTRODUCTION

This study aimed to elucidate the bacterial profile of chronic rhinosinusitis (CRS) in patients with end-stage renal disease (ESRD) and chronic kidney disease (CKD) compared with nonrenal patients, guiding antibiotic selection for clinicians.

METHODS

We retrospectively analyzed 13,906 inpatients from the Chang Gung Research Database who underwent sinus surgery (2004-2018). Patients were categorized into ESRD-CRS, CKD-CRS, and non-CKD-CRS based on the estimated glomerular filtration rate. Bacterial cultures from surgical samples were classified as facultative anaerobes or aerobes (e.g., Klebsiella pneumoniae [KP], Pseudomonas aeruginosa [Ps.a]), anaerobes, and fungi and ranked by prevalence.

RESULTS

Data from 47 ESRD-CRS, 230 CKD-CRS, and 13,123 non-CKD-CRS patients were analyzed. In ESRD-CRS, the predominant species were KP (31.6%), Ps.a (21.1%), and Coagulase-negative Staphylococcus (CoNS, 15.8%). CKD-CRS showed Staphylococcus epidermidis (27.7%), CoNS (20.5%), and Ps.a (20.5%). Non-CKD-CRS had Staphylococcus epidermidis (29.8%), CoNS (25.0%), and Staphylococcus aureus (15.5%). For anaerobes, ESRD-CRS was dominated by Fusobacterium nucleatum (10.5%) and Peptostreptococcus micros (10.5%), whereas CKD-CRS and non-CKD-CRS showed Propionibacterium acnes as a primary strain (14.5% and 28.7%, respectively).

CONCLUSION

For CRS in ESRD, antibiotics targeting KP and Fusobacterium nucleatum are recommended. In CKD-CRS, a focus on Staphylococcus epidermidis and Propionibacterium acnes is suggested.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3499-3507, 2024.

摘要

引言

本研究旨在阐明终末期肾病（ESRD）和慢性肾病（CKD）患者慢性鼻-鼻窦炎（CRS）的细菌谱，并与非肾病患者进行比较，为临床医生选择抗生素提供指导。

方法

我们回顾性分析了长庚研究数据库中13906例接受鼻窦手术的住院患者（2004 - 2018年）。根据估计的肾小球滤过率，将患者分为ESRD-CRS、CKD-CRS和非CKD-CRS组。手术样本的细菌培养物分为兼性厌氧菌或需氧菌（如肺炎克雷伯菌[KP]、铜绿假单胞菌[Ps.a]）、厌氧菌和真菌，并按患病率排序。

结果

分析了47例ESRD-CRS、230例CKD-CRS和13123例非CKD-CRS患者的数据。在ESRD-CRS中，主要菌种为KP（31.6%）、Ps.a（21.1%）和凝固酶阴性葡萄球菌（CoNS，15.8%）。CKD-CRS显示表皮葡萄球菌（27.7%）、CoNS（20.5%）和Ps.a（20.5%）。非CKD-CRS有表皮葡萄球菌（29.8%）、CoNS（25.0%）和金黄色葡萄球菌（15.5%）。对于厌氧菌，ESRD-CRS以具核梭杆菌（10.5%）和微小消化链球菌（10.5%）为主，而CKD-CRS和非CKD-CRS则以痤疮丙酸杆菌为主要菌株（分别为14.5%和28.7%）。