在HCT前的抗体干扰预测了儿科移植接受者的ESBL基因扩展:一个前性的多中心研究
medRxiv : the preprint server for health sciences
|February 9, 2026
概括
在血造细胞移植 (HCT) 之前肠道微生物组的破坏显著增加了扩展谱β-乳糖酶 (ESBL) 基因. 在HCT之前对抗生素的管理对于预防儿科移植接受者的感染至关重要.
科学领域:
- 微生物学 微生物学
- 基因组学就是基因组学.
- 儿科医学 儿科医学
背景情况:
- 感染是儿科血造细胞移植 (HCT) 后死亡的主要原因.
- 肠道微生物组有机体是儿科HCT患者高达90%的细菌病的来源.
- 这些微生物组中抗性基因的选择机制,如扩展谱β-乳糖酶 (ESBL),尚不清楚.
研究的目的:
- 为了研究多药耐药细菌在儿科HCT接受者的肠道微生物组内的变化,在移植后的早期.
- 了解驱动ESBL基因在这些脆弱患者的肠道微生物组扩张的因素.
主要方法:
- 从五个中心的133名儿科HCT接受者的潜在便样本采集.
- 用MEGARes数据库对细菌DNA进行枪支元基因组测序,以识别抗生素耐药性基因.
- 使用单变量和逆治疗权重概率 (IPTW) 线性回归进行统计分析,以评估ESBL基因丰度和抗生素暴露之间的关联.
主要成果:
- 在HCT中预先存在的肠道微生物组破坏与ESBL基因扩张的相关性比移植后的抗生素暴露更强.
- 与健康儿童相比,基线抗体距离较高的患者在中性质衰竭期间表现出ESBL基因的增加.
- 虽然移植后的β-乳酸暴露在被殖民的患者中没有增加ESBL基因,但氨基糖化物和无氧抗生素与新的ESBL生物体的获取有关.
结论:
- 在HCT之前对抗生素的管理对于预防ESBL相关的感染至关重要.
- 在早期移植期间尽量减少无氧活性抗生素的使用也可能有助于减少ESBL的获得.
- 解决先前存在的肠道微生物组破坏是控制HCT后耐药细菌选择的关键.
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