无色杆菌种类的临床和微生物学特征:一个10年,多中心的经验。

IF 5.4 2区 医学 Q1 MICROBIOLOGY
David R Bayless, Mitchell G Dumais, Jack W McHugh, Nischal Ranganath, Madiha Fida, Supavit Chesdachai, Omar M Abu Saleh
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引用次数: 0

摘要

无色杆菌是革兰氏阴性杆菌,主要影响囊性纤维化患者或免疫功能低下患者。由于无色杆菌物种的罕见性和物种水平鉴定的挑战,临床和微生物学数据有限。我们对3个梅奥诊所(明尼苏达州、亚利桑那州和佛罗里达州)的所有血液和非血液无色杆菌分离株进行了10年回顾性分析(2013年1月1日至2023年3月14日)。此外,我们检查了成人患者血液分离无色杆菌的临床特征。共分离出1598株无色杆菌,包括1545株非血液分离株和53株血液分离株。最常见的鉴定种是xylosoxidans无色杆菌,尽管许多分离株无法进行种水平的鉴定。成人无色杆菌血流感染患者的平均年龄为58.3岁(标准差±16.7),73.1%的患者有中心静脉导管,59.6%的患者免疫功能低下。30天和90天的全因死亡率分别为10.2%和18.4%。血液分离株对美罗培南、哌拉西林-他唑巴坦和甲氧苄啶-磺胺甲恶唑的敏感性大于90%。呼吸道是非血流分离株最常见的来源(57.5%)。非血流分离株对亚胺培南(94.6%)、哌拉西林-他唑巴坦(92.8%)、甲氧苄啶-磺胺甲新唑(92.1%)、美罗培南(87.5%)敏感,对氟喹诺酮类药物和氨基糖苷类药物耐药。我们的研究结果支持使用哌拉西林-他唑巴坦、碳青霉烯类或甲氧苄啶-磺胺甲恶唑作为无色杆菌感染的初始治疗。需要进一步的研究来更好地定义无色杆菌感染的临床和微生物学特征。无色杆菌是一种罕见但重要的细菌属,在囊性纤维化、复发性医疗保健暴露和/或免疫功能低下的患者中容易引起感染。关于无色杆菌感染的临床概况以及受影响患者的最佳抗生素选择的数据有限。我们进行了一项回顾性研究,以提高对无色杆菌的微生物学和临床特征的了解。我们的研究包括对2013年至2023年在明尼苏达州、佛罗里达州和亚利桑那州的三家梅奥诊所三级护理中心处理的所有无色杆菌分离株进行的10年调查。我们报告了多项发现,包括血液感染无色杆菌患者的临床特征,鉴定出的不同无色杆菌种类的数量,以及未从血液培养中获得的分离株的来源。此外,我们提出了抗菌敏感性结果的无色杆菌分离。我们的研究为临床医生治疗无色杆菌感染提供了指导,并希望能促进正在进行的无色杆菌研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical and microbiologic features of Achromobacter species: a 10-year, multicenter experience.

Achromobacter species are Gram-negative bacilli that predominantly affect individuals with cystic fibrosis or those with immunocompromising conditions. Clinical and microbiologic data on Achromobacter species are limited due to the rarity of these organisms and challenges with species-level identification. We conducted a 10-year retrospective analysis (1 January 2013 to 14 March 2023) of all bloodstream and non-bloodstream Achromobacter isolates identified at three tertiary-care Mayo Clinic locations (Minnesota, Arizona, and Florida). Additionally, we examined clinical characteristics of adult patients with Achromobacter bloodstream isolates. A total of 1,598 Achromobacter isolates, encompassing 1,545 non-bloodstream isolates and 53 bloodstream isolates, were identified. The most frequently identified species was Achromobacter xylosoxidans, though species-level identification was not possible for many isolates. Among adult patients with Achromobacter bloodstream infection, the mean age was 58.3 years (standard deviation ± 16.7), 73.1% had a central venous catheter, and 59.6% were immunocompromised. All-cause mortality was 10.2% at 30 days and 18.4% at 90 days. Bloodstream isolates exhibited greater than 90% susceptibility to meropenem, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole. The respiratory tract was the most common source of non-bloodstream isolates (57.5%). Non-bloodstream isolates showed high susceptibility to imipenem (94.6%), piperacillin-tazobactam (92.8%), trimethoprim-sulfamethoxazole (92.1%), and meropenem (87.5%) while demonstrating significant resistance to fluoroquinolones and aminoglycosides. Our findings support the use of piperacillin-tazobactam, carbapenems, or trimethoprim-sulfamethoxazole as initial therapy for Achromobacter infections. Further research is needed to better define the clinical and microbiologic characteristics of Achromobacter infections.IMPORTANCEAchromobacter is a rare but important genus of bacteria that tends to cause infection in those with cystic fibrosis, recurrent healthcare exposures, and/or an immunocompromising condition. There is limited data on the clinical profile of Achromobacter infections as well as optimal antibiotic selection for affected patients. We conducted a retrospective study to improve understanding of the microbiologic and clinical characteristics of Achromobacter. Our study consists of a 10-year survey of all Achromobacter isolates processed by three Mayo Clinic tertiary-care centers in Minnesota, Florida, and Arizona from 2013 to 2023. We report multiple findings, including the clinical characteristics of patients with Achromobacter bloodstream infection, the number of different Achromobacter species identified, and the sources of isolates not obtained from blood cultures. We additionally present antimicrobial susceptibility results for Achromobacter isolates. Our study provides guidance to clinicians treating Achromobacter infections and, it is hoped, will facilitate ongoing study of Achromobacter.

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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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