减少Clostridioides difficile中的万科米辛敏感性与特定的核糖类型有关
Taryn A Eubank1, Chetna Dureja2, Anne J Gonzales-Luna1
1Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA.
Open forum infectious diseases
|November 8, 2024
概括
某些Clostridioides difficile核型,特别是RT 027,是减少万科胺素敏感性的主要危险因素. 加强对这些菌株的监测对于指导治疗决策至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 临床医学 临床医学
背景情况:
- 在*Clostridioides difficile*分离物中降低了米素 (VAN) 敏感性,与较差的患者结局有关.
- 导致这些不那么易受感染的菌株感染的因素在很大程度上是未知的.
- 了解这些因素对于有效的感染控制和治疗至关重要.
研究的目的:
- 在临床 *C. difficile* 隔离物中确定与减少万科米辛敏感性相关的特定风险因素.
- 分析宿主,病原体和医院特征,以预测减少VAN易感性的感染.
- 为*C. difficile*感染提供临床实践和监测策略的信息.
主要方法:
- 一项多中心队列研究,涉及2016年至2021年*C. difficile*感染 (CDI) 的住院成人患者.
- 在临床隔离物上进行了阿格拉稀释VAN敏感性测试和 рибо型定型.
- 医学图表审查和多变量分析被用来确定减少VAN易感性的预测因素.
主要成果:
- 在594个隔离物中,29%的VAN敏感性降低 (MIC>2μg/mL).
- рибо型027 (RT 027) 和RT 255与减少VAN敏感性 (OR分别为13.4和2.9) 有显著的关联.
- рибо型014-020 (RT 014-020) 隔离物更容易对VAN (OR 0.41) 敏感,降低敏感性菌株的流行率随着时间的推移而增加.
结论:
- 特定的 *C. difficile* 核型,特别是 RT 027,是减少万科素敏感性的唯一独立预测因素.
- 没有患者或住院特征独立预测了感染的降低敏感性菌株.
- 建议加强对RT 027和其他降低敏感性菌株的临床监测,以指导抗生素处方.
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