Value of integron detection for predicting antibiotic resistance in patients with Gram-negative septicaemia
Value of integron detection for predicting antibiotic resistance in patients with Gram-negative septicaemia
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DOI：
10.1016/j.ijantimicag.2014.06.008
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发表时间：
2014-10-01
影响因子：
10.8
通讯作者：
Ploy, Marie-Cecile
中科院分区：
文献类型：
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作者：
Barraud, Olivier;Francois, Bruno;Ploy, Marie-Cecile
多重耐药肠杆菌科细菌是一个主要的公共卫生威胁，并使经验性抗生素治疗的药物选择复杂化，特别是在需要快速、适当治疗的脓毒症患者中。本研究的目的是通过直接检测阳性血培养物来研究整合子作为败血症致病肠杆菌科获得性抗生素耐药性的全球预测标志物的价值。整合子遗传标记可以在一次测试中检测到，而需要多次PCR来检测数百个已知的抗生素抗性基因。共纳入166例阳性血培养，并在阳性血培养和分离的肠杆菌科细菌中用定量PCR方法检测整合子。在阳性血培养上直接进行整合子检测的结果与分离的肠杆菌科中的整合子检测结果在98.8%的病例中一致。对第三代头孢菌素、氨基糖苷类、环丙沙星和甲氧苄啶/磺胺甲恶唑耐药的阴性预测值（NPV）>90%。在当前抗生素管理的背景下，这些良好的NPV表明这种方法可能有助于保存广谱抗生素。必须确认该概念验证研究的结果，以证明整合子检测的临床相关性，不仅在阳性血培养中，而且为了赢得时间，在原始生物样品中。(C)2014年Elsevier B. V.和国际化疗学会。All rights reserved.
Multidrug-resistant Enterobacteriaceae are a major public health threat and complicate the choice of drugs for empirical antibiotic therapy, especially in sepsis patients who require rapid, appropriate treatment. The objective of this study was to examine the value of integrons as a global predictive marker of acquired antibiotic resistance in septicaemia-causing Enterobacteriaceae by direct detection in positive blood cultures. The integron genetic marker can be detected in a single test, whereas multiple PCRs are needed to detect the hundreds of known antibiotic resistance genes. A total of 166 positive blood cultures were included in the study, and integrons were detected with a quantitative PCR method both in positive blood cultures and isolated Enterobacteriaceae. The results of integron detection directly on positive blood cultures were consistent in 98.8% of cases with integron detection in isolated Enterobacteriaceae. Negative predictive values (NPVs) were >90% for resistance to third-generation cephalosporins, aminoglycosides, ciprofloxacin and trimethoprim/sulfamethoxazole. In the current context of antibiotic stewardship, these good NPVs indicate that this method might be useful for preserving broad-spectrum antibiotics. The results of this proof-of-concept study must be confirmed in order to demonstrate the clinical relevance of integron detection, not only in positive blood cultures but also, to gain time, in raw biological samples. (C) 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.