对于复发的Enterococcus faecium细菌病的细菌体和抗生素联合治疗
Madison E Stellfox1, Carolyn Fernandes1, Ryan K Shields1
1Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
mBio
|February 14, 2024
概括
与抗生素相结合的菌体疗法改善了患有复发性抗万科胺素耐药Enterococcus faecium感染的患者的治疗结果. 抗抗体反应最终限制了治疗的有效性,突出了菌体疗法.
科学领域:
- 微生物学 微生物学
- 传染性疾病 传染性疾病
- 治疗方法 治疗方法
背景情况:
- 肠杆菌 (Enterococcus faecium) 是一种常见的肠道细菌,可以引起严重的抗生素耐药性感染,特别是在免疫受损的个体中.
- 抗菌素的E. faecium (VREfm) 是一个重要的医院病原体,治疗选择有限,往往导致治疗失败和复发性感染.
- 一项长达7年的病例研究追踪了对常规抗生素治疗无反应的复发性E. faecium血流感染 (BSI).
研究的目的:
- 评估菌体 (菌体) 治疗作为抗生素辅助治疗复发性抗生素耐药E. faecium感染的疗效.
- 研究菌体和抗生素治疗组合对VREfmBSI患者的细菌负担和临床结果的影响.
- 探索治疗失败的潜在机制,包括耐药性发展和宿主免疫反应.
主要方法:
- 全基因组测序 (WGS) 用于分析E. faecium菌株随着时间的推移的遗传相关性.
- 细菌治疗被添加到患者现有的抗生素治疗方案中.
- 在体外研究中评估了菌体和抗生素在抑制细菌生长方面的联合疗效.
主要成果:
- 与菌体和抗生素的联合治疗导致临床改善,并减少了患者胃肠道中的E. faecium和VRE负载.
- 在体外,结合疗法与单一疗法相比,显示出增强的细菌生长抑制.
- 脊髓炎的复发与获得的抗生素或菌体耐药性无关;然而,抗菌体抗体反应与增加的VRE丰度和临床失败相吻合.
结论:
- 菌体疗法作为侵袭性,抗生素耐药性肠球菌感染的额外治疗方式具有前景.
- 抗菌素中和抗体的发展可能会限制治疗疗效.
- 进一步的研究对于优化菌体治疗的部署和克服最大临床益处的局限性至关重要.
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