Association between cytotoxic and invasive Pseudomonas aeruginosa and clinical outcomes in bacterial keratitis.
Association between cytotoxic and invasive Pseudomonas aeruginosa and clinical outcomes in bacterial keratitis.
复制标题
DOI：
10.1001/jamaophthalmol.2013.778
复制
发表时间：
2013-02
影响因子：
8.1
通讯作者：
Acharya, Nisha R.
中科院分区：
文献类型：
--
作者：
Borkar, Durga S.;Fleiszig, Suzanne M. J.;Leong, Chelsia;Lalitha, Prajna;Srinivasan, Muthiah;Ghanekar, Avanti A.;Tam, Connie;Li, Wing Y.;Zegans, Michael E.;McLeod, Stephen D.;Lietman, Thomas M.;Acharya, Nisha R.
铜绿假单胞菌的临床分离株可根据其对宿主细胞的不同作用而被表征为细胞毒性或侵袭性的。先前的研究表明，菌株类型影响动物模型的病理学。本研究的目的是确定侵袭性和细胞毒性菌株是否对细菌性角膜炎的临床表现、结局或治疗反应有不同的影响。来自NEI资助的类固醇治疗角膜溃疡试验（SCUT）的铜绿假单胞菌分离株被分型为侵袭性或细胞毒性菌株。两种亚型之间比较的主要结果指标是使用Huber稳健回归，调整局部皮质类固醇治疗后3个月时视力的变化。在来自SCUT的101个确认的铜绿假单胞菌分离株中，74个具有典型的侵袭性或细胞毒性基因型。而当调整溃疡位置的影响时，基因型侵袭性铜绿假单胞菌菌株引起的角膜溃疡的视力明显优于基因型细胞毒性铜绿假单胞菌菌株引起的角膜溃疡（p=0.008），3个月时浸润性溃疡的改善显著低于细胞毒性溃疡（0.35 logMAR（3.5线差异），95% CI 0.04 - 0.66 p=0.03）。当与局部应用阿氟沙星单独治疗相比，局部应用皮质类固醇的连续治疗与侵入性亚组中视力的显著改善相关（p=0.04），但与细胞毒性亚组中视力的改善较少相关（p=0.07）。本研究的结果表明，差异表达的毒力决定因素，如铜绿假单胞菌的细胞毒性和侵袭性的合理分析，可以作为一种工具，在管理感染，以优化结果的决策。
Clinical isolates of Pseudomonas aeruginosa can be characterized as cytotoxic or invasive, based on their differing effects on host cells. Previous studies have shown that strain type influences pathology in animal models. The aim of this study was to determine if invasive and cytotoxic strains differentially impact clinical presentation, outcome, or therapeutic response in bacterial keratitis. P.aeruginosa isolates from the NEI-funded Steroids for Corneal Ulcers Trial (SCUT) were subtyped as invasive or cytotoxic strains. The main outcome measure compared between the two subtypes was change in visual acuity at three months using Huber robust regression, adjusting for topical corticosteroid treatment. Of the 101 confirmed P.aeruginosa isolates from the SCUT, 74 had a classically invasive or cytotoxic genotype. While corneal ulcers caused by genotypically invasive P.aeruginosa strains presented with significantly better visual acuity than those caused by genotypically cytotoxic P.aeruginosa strains when adjusting for the effect of ulcer location (p=0.008), invasive ulcers improved significantly less than cytotoxic ulcers at three months (0.35 logMAR (three and a half line difference), 95% CI 0.04 to 0.66 p=0.03). When compared with topical moxifloxacin alone, adjunctive treatment with topical corticosteroids was associated with significantly more improvement in visual acuity in the invasive subgroup (p=0.04), but was associated with less improvement in vision in the cytotoxic subgroup (p=0.07). The results of this study suggest that rational profiling of differentially expressed virulence determinants, e.g. cytotoxicity and invasiveness for P.aeruginosa, could be used as a tool for decision making in management of infections to optimize outcome.
登录
查看更多内容
影响因子：
3.1
作者：
FLEISZIG, SMJ;ZAIDI, TS;PIER, GB
通讯作者：
PIER, GB
DOI：
10.1038/nrmicro2199
发表时间：
2009-09
期刊：
Nature reviews. Microbiology
影响因子：
--
作者：
通讯作者：
--
影响因子：
3.6
作者：
FinckBarbancon, V;Goranson, J;Frank, DW
通讯作者：
Frank, DW
影响因子：
--
作者：
ASBELL, P;STENSON, S
通讯作者：
STENSON, S
影响因子：
3.1
作者：
Ni, M;Evans, DJ;Fleiszig, SMJ
通讯作者：
Fleiszig, SMJ