在甲素敏感黄金葡萄球菌感染性内心炎中β-Lactam Inoculum的作用
Baptiste Jean1, Maelys Crolle2, Candice Pollani2
1Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
JAMA network open
|December 20, 2024
概括
由金黄色葡萄球菌引起的传染性内心炎 (IE) 的死亡率很高. 对甲素敏感的金黄色菌株 (MSSA) 的注射效应增加了死亡风险,这表明这应该指导治疗.
科学领域:
- 传染性疾病 传染性疾病
- 微生物学 微生物学
- 药理学 药理学是指药理学的学科.
背景情况:
- 由黄金葡萄球菌引起的传染性内心炎 (IE) 的死亡率很高,近几十年来没有显著改善.
- 目前的指导方针推抗菌性青素或塞法林用于对甲素敏感的金黄色细菌 (MSSA) IE,认为它们同样有效.
- 一些MSSA菌株拥有blaZ基因,导致一种称为注射剂效应的现象,在高细菌度下,抗生素有效性降低,这与IE植被有关的条件.
研究的目的:
- 调查S. aureus分离物体的表型特征,使用的特定β-乳糖抗生素和MSSA IE患者的结果之间的关联.
- 为了确定blaZ基因的存在或注射剂效应是否会影响MSSA患者的死亡率.
主要方法:
- 一个追溯的病例系列,包括2016年至2022年期间在法国三所大学医院治疗的216名MSSAIE患者.
- 测试了MSSA分离物对blaZ基因的检测,以及对塞法林和西林的注射效应.
- 这项研究评估了第一月死亡率与使用的β-乳糖胺,blaZ存在和注射剂效应之间的关联.
主要成果:
- 左侧IE的1个月死亡率为24.4%,而抗菌素青素和塞法林治疗之间没有显著差异.
- 与blaZ阴性菌株 (11.8%) 相比,感染blaZ阳性菌株 (29.5%) 的患者的死亡率更高.
- 与没有 (19.4%) 相比,感染了表现出注射效应的菌株的患者的1个月死亡率 (40.3%) 显着更高. 接种剂效应是死亡的独立风险因素 (HR, 2.84).
结论:
- 在MSSA分离物中存在注射效应是IE患者早期死亡的重要风险因素.
- 对MSSA分离物体进行注射效应的表型检测可能对指导选择β-乳酸抗生素至关重要.
- 根据注射剂效应量身定制抗生素选择可能会改善MSSA IE的治疗结果.
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