Emergence and transmission of amantadine-resistant influenza A in a nursing home.
Emergence and transmission of amantadine-resistant influenza A in a nursing home.
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疗养院中金刚烷胺耐药甲型流感的出现和传播。
DOI：
10.1111/j.1532-5415.2004.52567.x
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发表时间：
2004
影响因子：
6.3
通讯作者：
Shult,Peter
中科院分区：
文献类型：
--
作者：
Schilling,Margo;Gravenstein,Stefan;Drinka,Paul;Cox,Nancy;Krause,Peggy;Povinelli,Laura;Shult,Peter
目的：当金刚烷胺用于甲型流感爆发控制时，前瞻性检测金刚烷胺耐药流感。设计：在金刚烷胺预防期间，对所有新发呼吸道疾病进行前瞻性临床监测和病毒培养。设置：在甲型流感爆发期间（1993-94年），一家721张床位，14间病房的退伍军人及其配偶疗养院。参与者：退伍军人医院的居民及其配偶。测量：鼻咽和咽喉病毒培养。所有的居民与阳性培养谁开发新的呼吸道症状，而接收或居住在一个单位接受金刚烷胺预防进行了抗病毒耐药性检测和聚合酶链反应限制性分析performed.Results：金刚烷胺预防顺序给药的14个病房的9个所有居民以及14至31天/病房，以控制流感爆发1993年12月9日和1994年1月28日之间。同时向29名患病居民提供了金刚烷胺治疗。1993年12月3日至1994年1月22日期间，检测到68例甲型流感培养阳性病例。20例受试者正在接受或居住在接受金刚烷胺预防治疗的单位。16名居民可进行金刚烷胺敏感性试验，12名居民有金刚烷胺耐药菌株。12人中有4人没有接受任何抗病毒治疗。疾病发作范围为1至22天后，金刚烷胺预防开始对个人的单位。在编码M2蛋白跨膜区的基因中观察到两个在时间和空间上聚集的核糖核酸（RNA）突变。从两个室友，一个接受金刚烷胺18天，一个没有抗病毒药物的分离株，有相同的RNA sequence.Conclusion：抗病毒耐药性可能是负责失败的预防护理之家爆发。使用不同类别的抗病毒药物进行预防和治疗的策略可能会限制耐药病毒的出现和传播。
Objectives:To prospectively detect amantadine‐resistant influenza when amantadine was used for influenza A outbreak control.Design:Prospective clinical surveillance and viral culture of all new respiratory illnesses during the course of amantadine prophylaxis.Setting:A 721‐bed, 14‐ward nursing home for veterans and spouses during an influenza A outbreak (1993–94).Participants:Residents of a veterans hospital and their spouses.Measurements:Nasopharyngeal and throat viral culture. All residents with positive cultures who developed new respiratory symptoms while receiving or residing on a unit receiving amantadine prophylaxis had antiviral‐resistance testing and polymerase chain reaction restriction analyses performed.Results:Amantadine prophylaxis was administered sequentially on nine of 14 wards to all well residents for 14 to 31 days/ward to control influenza outbreaks between December 9, 1993, and January 28, 1994. Amantadine treatment was simultaneously provided to 29 ill residents. Between December 3, 1993, and January 22, 1994, 68 culture‐positive cases of influenza A were detected. Twenty subjects were receiving or residing on units receiving amantadine prophylaxis. Amantadine sensitivity testing could be performed on 16 residents; 12 residents had amantadine resistant strains. Four of the 12 had not received any antiviral treatment. Illness onset ranged from 1 to 22 days after amantadine prophylaxis was begun on the individual's unit. Two ribonucleic acid (RNA) mutations in the gene coding the M2 protein transmembrane region were observed that were clustered in time and space. Isolates from two roommates, one receiving amantadine for 18 days and one on no antiviral, had identical RNA sequences.Conclusion:Antiviral resistance may be responsible for failure of prophylaxis in nursing home outbreaks. Strategies that use different classes of antivirals for prophylaxis and treatment may limit emergence and transmission of resistant virus.