Emergence of Resistance to Azithromycin-Atovaquone in Immunocompromised Patients with Babesia microti Infection
Emergence of Resistance to Azithromycin-Atovaquone in Immunocompromised Patients with Babesia microti Infection
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DOI：
10.1086/649859
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发表时间：
2010-02-01
影响因子：
11.8
通讯作者：
Krause, Peter J.
中科院分区：
文献类型：
--
作者：
Wormser, Gary P.;Prasad, Aakanksha;Krause, Peter J.
背景巴贝西虫病是一种新出现的蜱传疟疾样感染，主要由田鼠巴贝虫引起。这种感染通常会自行消退，或在阿奇霉素加阿托伐醌或克林霉素加奎宁治疗7-10天后消退。尽管某些免疫功能高度低下的患者可能对这些药物治疗方案的反应不佳，但与疟疾的情况不同，没有报道的证据表明治疗失败的原因是感染了B的耐药菌株。microti.Methods. B出现耐药。Microti定义为患者在不间断抗巴贝斯虫药物治疗>= 28天后仍在接受治疗时发生与临床和实验室异常指示活动性巴贝斯虫病相关的微生物复发（复发性寄生虫血症或寄生虫血症显著增加）。3个高度免疫功能低下的患者接受阿奇霉素阿托伐醌亚治愈过程与最终发展耐药这种药物方案的临床病例的历史进行了描述。3例患者中1例死于巴贝虫病相关并发症。B。在用这种联合药物方案治疗高度免疫功能低下患者的巴贝虫病期间，Microti可能对阿奇霉素-阿托伐醌产生耐药性。虽然需要研究来确定高度免疫功能低下的巴贝虫病患者的最佳治疗方法，但在可能的情况下降低免疫抑制水平似乎是一种可取的策略。
Background. Babesiosis is an emerging tickborne malaria-like infection principally caused by Babesia microti. This infection typically resolves either spontaneously or after administration of a 7-10-day course of azithromycin plus atovaquone or clindamycin plus quinine. Although certain highly immunocompromised patients may respond suboptimally to these drug regimens, unlike the situation with malaria there has been no reported evidence that the cause of treatment failure is infection with drug-resistant strains of B. microti.Methods. Emergence of drug resistance in B. microti was defined as the development of a microbiologic relapse (recurrent parasitemia or a marked increase in parasitemia) in association with both clinical and laboratory abnormalities indicative of active babesiosis in a patient after >= 28 days of uninterrupted antibabesia drug therapy and while still receiving treatment.Results. The clinical case histories of 3 highly immunocompromised patients who received a subcurative course of azithromycin-atovaquone associated with the eventual development of resistance to this drug regimen are described. One of the 3 patients died of complications related to babesiosis.Conclusions. B. microti may become resistant to azithromycin-atovaquone during the treatment of babesiosis with this combined drug regimen in highly immunocompromised patients. Although research is needed to determine the optimal therapy for highly immunocompromised patients with babesiosis, reducing the level of immunosuppression when possible would appear to be a desirable strategy.