肿瘤患者的纹状棒状杆菌感染:临床谱、耐药概况和医院传播的证据。

IF 5.4 2区 医学 Q1 MICROBIOLOGY
Kenya Yukawa, Sohei Harada, Kohji Komori, Brian Hayama, Daisuke Ohkushi, Koichi Takeda, Taisuke Enokida, Akira Yarimizu, Kazumi Takehana, Kageto Yamada, Michihiko Goto, Kazuhiro Tateda
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引用次数: 0

摘要

在棒状杆菌种类中,纹状棒状杆菌相对频繁地参与侵袭性人类感染。在本研究中,我们收集了单个癌症中心诊断为纹状体梭菌感染的患者的临床资料,并进行了抗菌药敏试验和致病菌株的全基因组测序。51例纹状体感染患者中,术后腹腔感染15例(29.4%),颈部皮肤及软组织感染8例(15.7%),骨关节感染8例(15.7%)。在15例患者中,纹状体梭菌与其他细菌同时检出。抗菌药物治疗的中位持续时间为25天,43例(84.3%)患者在第14天出现临床改善。诊断后90天的粗死亡率为15.7%。万古霉素是最常用的最终治疗药物,40例(78.4%)患者接受了多种抗菌药物治疗。口服二甲胺四环素常用于需要长期治疗的患者。对53株病原菌进行药敏试验,其中2株来自同一患者的随访培养,结果显示大多数病原菌对达托霉素和四环素类药物敏感。然而,2株(3.8%)和4株(7.5%)对达托霉素和四环素不敏感,均与psgA2突变和tet(W)携带相关。菌株的核心基因组单核苷酸多态性分析和源患者的流行病学回顾确定了三个可疑的医院传播聚集性,涉及7名患者。本研究表明纹状体梭菌可在有基础疾病(如恶性肿瘤)的患者中引起一系列感染,并且该病原体也可能发生院内传播。重要性:本研究采用基质辅助激光解吸/电离飞行时间质谱法进行细菌种类鉴定,增强了临床微生物实验室对纹状棒状杆菌作为重要人类病原体的认识。我们的研究表明纹状体梭菌与各种医疗保健相关感染有关,包括那些需要长期抗菌治疗的感染,并且这种病原体的医院传播可导致感染的发展。此外,万古霉素以外的一些药物,如替柯planin、四环素和甲氧苄啶/磺胺甲恶唑,已显示出良好的活性。本研究结果表明,鉴于万古霉素的潜在副作用,需要进一步研究纹状体梭菌的医院传播机制和方式,以及万古霉素替代药物的临床疗效,特别是适合长期治疗的药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Corynebacterium striatum infections in oncologic patients: clinical spectrum, resistance profiles, and evidence of nosocomial transmission.

Among Corynebacterium species, Corynebacterium striatum is relatively frequently involved in invasive human infections. In this study, we collected clinical information from patients diagnosed with C. striatum infection at a single cancer center and performed antimicrobial susceptibility testing and whole-genome sequencing of the causative strains. Of the 51 patients with C. striatum infections, 15 (29.4%) had postoperative intra-abdominal infections, eight (15.7%) had postoperative skin and soft tissue infections of the neck, and eight (15.7%) had osteoarticular infections. In 15 patients, C. striatum was detected concomitantly with other bacteria. The median duration of antimicrobial therapy was 25 days, with 43 patients (84.3%) showing clinical improvement by day 14. The crude mortality up to 90 days post-diagnosis was 15.7%. Vancomycin was the most commonly used definitive therapy, and 40 patients (78.4%) received multiple antimicrobial agents. Oral minocycline was often administered in patients requiring long-term treatment. Antimicrobial susceptibility testing of 53 strains, including two strains from follow-up cultures from the same patient, showed that most strains were susceptible to daptomycin and tetracyclines. However, non-susceptibility was noted in two strains (3.8%) for daptomycin and four strains (7.5%) for tetracyclines, each associated with psgA2 mutation and tet(W) carriage. Core-genome single-nucleotide polymorphism analysis of the strains and epidemiological reviews of the source patients identified three suspected clusters of nosocomial transmission involving seven patients. This study demonstrated that C. striatum can cause a range of infections in patients with underlying diseases, such as malignancy, and that nosocomial spread of this pathogen may also occur.

Importance: The use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, employed for bacterial species identification in this study, has enhanced the recognition of Corynebacterium striatum as an important human pathogen in clinical microbiology laboratories. Our study demonstrated that C. striatum is associated with various healthcare-associated infections, including those requiring prolonged antimicrobial therapy, and that nosocomial transmission of this pathogen can result in the development of infections. In addition, several agents other than vancomycin, such as teicoplanin, tetracyclines, and trimethoprim/sulfamethoxazole, have demonstrated favorable activities. The results of this study indicate the need for further research on the mechanisms and modes of nosocomial transmission of C. striatum, as well as the clinical efficacy of alternative agents to vancomycin, particularly those suitable for prolonged treatment, given the potential side effects associated with vancomycin use.

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来源期刊
Journal of Clinical Microbiology
Journal of Clinical Microbiology 医学-微生物学
CiteScore
17.10
自引率
4.30%
发文量
347
审稿时长
3 months
期刊介绍: The Journal of Clinical Microbiology® disseminates the latest research concerning the laboratory diagnosis of human and animal infections, along with the laboratory's role in epidemiology and the management of infectious diseases.
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