导致侵袭性肺炎的阿莫西西林不敏感的肺炎菌:血清型,克隆和临床影响
Jordi Càmara1,2, Inmaculada Grau2,3, Aida González-Díaz1,2
1Department of Clinical Microbiology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.
在侵袭性肺炎球菌性肺炎中,阿莫西西林的不敏感性保持稳定. 阿莫西西林治疗与死亡率高于类药物有关,特别是在严重病例中.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 流行病学 流行病学
背景情况:
- 氨基西林是肺炎球菌感染的主要抗生素.
- 了解阿莫西西林不敏感性对于有效治疗侵入性肺炎球菌性肺炎至关重要.
- 需要关于阿莫西西林耐药性趋势和临床结果的长期数据.
研究的目的:
- 分析阿莫西西林在侵袭性肺炎球菌肺炎中不敏感的流行病学.
- 评估与阿莫西西林不敏感性相关的临床影响和死亡率.
- 为了比较阿莫西西林与第三代化在治疗这些感染的结果.
主要方法:
- 使用从1994年至2020年前性收集的数据进行的观察性研究.
- 对1663例侵入性肺炎球菌性肺炎病例的分析.
- 使用Cox比例危险模型评估抗生素敏感性,血清型,基因型,临床特征和30天死亡率.
主要成果:
- 氨基素敏感性从72.9%增加到91.4%,但MIC>2 mg/L保持稳定 (4.8%-5.3%).
- 一个单一的血统 (GPSC6) 主导着不敏感的菌株.
- 高麦卡贝得分,白血病,休克,呼吸衰竭和双巴肺炎与死亡率有关.
- 阿莫西西林治疗的死亡风险高于类药物,特别是MIC> 2 mg/L和严重病例.
结论:
- 尽管阿莫西西林敏感性增加,但仍然存在稳定比例的非敏感菌株.
- 宿主因素显著影响侵袭性肺炎球菌肺炎的结果.
- 与第三代头素相比,阿莫西西林可能会产生较差的结果,特别是在患有严重疾病或高MIC值的患者中.
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