Englund J A, Champlin R E, Wyde P R, Kantarjian H, Atmar R L, Tarrand J, Yousuf H, Regnery H, Klimov A I, Cox N J, Whimbey E
Acute Viral Respiratory Diseases Unit, Baylor College of Medicine, Houston, Texas 77030, USA.
Clin Infect Dis. 1998 Jun;26(6):1418-24. doi: 10.1086/516358.
The importance and significance of amantadine- or rimantadine-resistant influenza viruses in immunocompromised patients was studied in a population of adult bone marrow transplant (BMT) recipients and patients with leukemia prospectively cultured for respiratory viruses. Influenza A viruses were isolated from 29 patients with acute respiratory illness (14 BMT recipients and 15 patients with leukemia). Fifteen patients (52%) received amantadine (n = 4) or rimantadine (n = 11) therapy. All influenza isolates recovered from six patients shedding virus for > or = 3 days were screened for antiviral susceptibility; resistant isolates were further genetically characterized. Initial influenza isolates were susceptible to amantadine or rimantadine, but subsequent isolates from five of six patients were resistant. Influenza-associated mortality was similar among patients with and without documented antiviral resistance (2 of 5 vs. 5 of 24). We conclude that development of antiviral resistance in immunocompromised individuals should be considered when they have been treated with antivirals and have shed influenza virus for a prolonged period. Isolation procedures should be instituted for all immunocompromised patients with influenza, both during and after therapy with amantadine or rimantadine.
在一组接受成人骨髓移植（BMT）的患者和白血病患者中，对金刚烷胺或金刚乙胺耐药流感病毒在免疫功能低下患者中的重要性和意义进行了前瞻性研究，这些患者均接受呼吸道病毒培养。从29例急性呼吸道疾病患者（14例BMT接受者和15例白血病患者）中分离出甲型流感病毒。15例患者（52%）接受了金刚烷胺（n = 4）或金刚乙胺（n = 11）治疗。对从6例病毒排出≥3天的患者中分离出的所有流感病毒进行抗病毒敏感性筛查；对耐药菌株进行进一步的基因特征分析。最初分离的流感病毒对金刚烷胺或金刚乙胺敏感，但6例患者中有5例随后分离出的病毒耐药。有和没有抗病毒耐药记录的患者中流感相关死亡率相似（5例中的2例 vs. 24例中的5例）。我们得出结论，当免疫功能低下个体接受抗病毒治疗且长时间排出流感病毒时，应考虑抗病毒耐药的发生。对于所有接受金刚烷胺或金刚乙胺治疗期间及之后患流感的免疫功能低下患者，均应采取隔离措施。
