Concordant genotype of upper and lower airways P aeruginosa and S aureus isolates in cystic fibrosis
Concordant genotype of upper and lower airways P aeruginosa and S aureus isolates in cystic fibrosis
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DOI：
10.1136/thx.2008.104711
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发表时间：
2009-06-01
期刊：
影响因子：
10
通讯作者：
Tuemmler, B.
中科院分区：
文献类型：
--
作者：
Mainz, J. G.;Naehrlich, L.;Tuemmler, B.
理由：下呼吸道 (LAW) 铜绿假单胞菌和金黄色葡萄球菌感染是囊性纤维化 (CF) 发病的主要原因。上呼吸道（UAW）被证明是获取机会性细菌的门户并充当它们的储存库。因此，需要对 CF 常规护理中的 UAW 评估工具进行评估。 目的：本研究的目的是对 UAW 和 LAW 微生物定植进行非侵入性评估，并对两个部位的铜绿假单胞菌和金黄色葡萄球菌菌株进行基因分型。 方法：对 182 名 CF 患者进行了评估（年龄 0.4-68 岁，中位年龄 17 岁）。 LAW标本优选作为咳痰取样，UAW标本通过鼻灌洗取样。分别通过信息性单核苷酸多态性 (SNP) 或 spa 分型对铜绿假单胞菌和金黄色葡萄球菌分离株进行分型。 结果：在来自同时 UAW 和 LAW 阳性标本的可分型金黄色葡萄球菌和铜绿假单胞菌分离株中，36 名患者中的 31 名携带相同的金黄色葡萄球菌 spa 型，24 名患者中的 23 名在两者中携带相同的铜绿假单胞菌 SNP 基因型。隔间。 LAW 标本中金黄色葡萄球菌或铜绿假单胞菌的检测与同一患者的 UAW 标本中鉴定出金黄色葡萄球菌或铜绿假单胞菌的可能性高出 15 或 88 倍相关。 结论：UAW 和 LAW 中存在相同的基因型表明，UAW 在 CF 中发挥着金黄色葡萄球菌和铜绿假单胞菌储存库的作用。鼻灌洗似乎适合非侵入性 UAW 采样，但需要进一步纵向分析并与侵入性方法进行比较。虽然常规 CF 护理中通常不会评估 UAW 细菌定植情况，但这些数据挑战了讨论该气道室的诊断和治疗标准的必要性。试验注册号：NCT00266474。
Rationale: Lower airway (LAW) infection with Pseudomonas aeruginosa and Staphylococcus aureus is the leading cause of morbidity in cystic fibrosis (CF). The upper airways (UAW) were shown to be a gateway for acquisition of opportunistic bacteria and to act as a reservoir for them. Therefore, tools for UAW assessment within CF routine care require evaluation.Objectives: The aims of the study were non-invasive assessment of UAW and LAW microbial colonisation, and genotyping of P aeruginosa and S aureus strains from both segments.Methods: 182 patients with CF were evaluated (age 0.4-68 years, median 17 years). LAW specimens were preferably sampled as expectorated sputum and UAW specimens by nasal lavage. P aeruginosa and S aureus isolates were typed by informative single nucleotide polymorphisms (SNPs) or by spa typing, respectively.Results: Of the typable S aureus and P aeruginosa isolates from concomitant UAW- and LAW-positive specimens, 31 of 36 patients were carrying identical S aureus spa types and 23 of 24 patients identical P aeruginosa SNP genotypes in both compartments. Detection of S aureus or P aeruginosa in LAW specimens was associated with a 15- or 88-fold higher likelihood also to identify S aureus or P aeruginosa in a UAW specimen from the same patient.Conclusions: The presence of identical genotypes in UAW and LAW suggests that the UAW play a role as a reservoir of S aureus and P aeruginosa in CF. Nasal lavage appears to be suitable for non-invasive UAW sampling, but further longitudinal analyses and comparison with invasive methods are required. While UAW bacterial colonisation is typically not assessed in regular CF care, the data challenge the need to discuss diagnostic and therapeutic standards for this airway compartment.Trial registration number: NCT00266474.