ベトナムにおける下呼吸道感染症の細菌的病因と抗菌剤の感受性
Tran Thi Ngoc Dung1, Chau Vinh1, Pham Hong Anh1
1Molecular Epidemiology Group, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
Annals of clinical microbiology and antimicrobials
|August 31, 2025
まとめ
この研究では,カルバペネム耐性細菌が,ベトナムの病院で得られた下呼吸道感染症 (LRTI) で一般的であることが判明した. Acinetobacter baumannii,Pseudomonas aeruginosa,およびKlebsiella pneumoniaeは高い耐性を示しており,治療に問題がある.
科学分野:
- 微生物学
- 感染症
- 抗菌剤に対する耐性
背景:
- 下呼吸道感染症 (LRTI) は,感染症による罹病率と死亡率の主要な原因です.
- 主要な細菌病原体には,アチネトバクテリア・バウマンニ,プセドモナス・エアルギノサ,クレブシエラ・プネモニア,エシェリキア・コライ,黄金のステーフィロコーカス,およびストレプトコッカス・プネモニアが含まれます.
- この研究では,ベトナムのLRTIsにおける細菌病原体の流行と抗菌剤耐性を調査した.
研究 の 目的:
- ベトナムのコミュニティと病院で得られたLRTIsを引き起こす主要な細菌病原体の流行を決定する.
- 多剤耐性 (MDR) とカルバペネム耐性を含む抗菌剤耐性パターンを分析する.
- セフタジドーム・アビバクタムやコリスチンなどの新薬に対する耐性を評価する.
主な方法:
- 2022年1月から2023年5月までの間,単離基監視で1000個の細菌単離が収集されました.
- 種識別と抗菌感受性試験は,VITEK-2/Phoenix M50,E-テスト,およびブーストの微細化を用いて行われました.
- マルチプレックスPCRと全ゲノム配列解析を用いて,抗菌剤耐性 (AMR) 遺伝子を検出した.
主要な成果:
- Acinetobacter baumannii (49. 6%),Pseudomonas aeruginosa (21%),およびKlebsiella pneumoniae (18. 6%) が主たる病原体であり,主に病院で得られたLRTIs (94. 4%) によるものであった.
- A. baumannii,P. aeruginosa,およびK. pneumoniaeでMDRおよびカルバペネム耐性の高い割合が観察されました.
- セフタジジーム・アビバクタムとコリスチンに対する有意な耐性があり,ブラNDM遺伝子の存在は耐性と相関しており,切断されたブラNDMの単離体を除く.
結論:
- カーバペネム耐性グラム陰性病原体は,ベトナムの病院で獲得されたLRTIsを支配し,特にAcinetobacter baumanniiの治療に重大な課題をもたらします.
- Klebsiella pneumoniaeとEscherichia coliではAMRのフェノタイプとゲノタイプの強い相関性が認められ,遺伝子誘導療法が支持された.
- 破壊された blaNDM の存在は,カルバペネマース検出アッセイの再評価の必要性を強調しています.
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