بررسي كلونيزاسيون ميكروبي و مقاومت دارويي در بيماران مبتلا به فيبروز كيستيك

Microbial Colonization and Drug Resistance in Cystic Fibrosis

ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ ﯾﮏ ﺑﯿﻤﺎري ژﻧﺘﯿﮑﯽ اﺗﻮزوﻣﺎل ﻏﺎﻟﺐ اﺳﺖ. اﯾﻦ ﺑﯿﻤﺎري ﺑﺎ ﻣﻮﺗﺎﺳﯿﻮن ژن ﺗﻨﻈﯿﻢ ﮐﻨﻨﺪه اﻧﺘﻘﺎل ﻏﺸﺎﯾﯽ ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ )CFTR( و اﻧﺘﻘﺎل ﻣﺨﺘﻞ ﯾﻮن ﮐﻠﺮاﯾﺪ از ﻏﺸﺎ ﺳﻠﻮﻟﯽ ﻣﺸﺨﺺ ﻣﯽ ﺷﻮد. اﺳﺘﺎﻓﯿﻠﻮﮐﻮك اورﺋﻮس، ﺳﻮدوﻣﻮﻧﺎس آﺋﺮوژﯾﻨﻮزا، ﺑﻮرﺧﻮﻟﺪرﯾﺎ ﺳﭙﺎﺳﯿﺎ در ﮐﺸﺖ ﺗﺮﺷﺤﺎت ﺗﻨﻔﺴﯽ ﺑﯿﻤﺎران ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ ﺷﻨﺎﺳﺎﯾﯽ ﺷﺪه و ﻋﻔﻮﻧﺖ ﻫﺎي اﯾﻦ ﻣﯿﮑﺮوارﮔﺎﻧﯿﺴﻢ ﻫﺎ ﺑﺎ ﻣﻮرﺑﯿﺪﯾﺘﯽ و ﻣﻮرﺗﺎﻟﯿﺘﯽ ﺑﺎﻻ در ارﺗﺒﺎط ﻫﺴﺘﻨﺪ. در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ، اﻟﺘﻬﺎب ﺷﺪﯾﺪ راه ﻫﺎي ﻫﻮاﯾﯽ ﻣﯽ ﺗﻮاﻧﺪ ﺳﺒﺐ ﺑﺮوﻧﺸﮑﺘﺎزي ﭘﯿﺸﺮﻓﺘﻪ ﺷﻮد ﮐﻪ ﻣﻤﮑﻦ اﺳﺖ ﺑﺎﻋﺚ ﻣﺸﮑﻞ ﺗﻨﻔﺴﯽ و ﻣﺮگ در اﯾﻦ ﺑﯿﻤﺎران ﮔﺮدد. ﻫﺪف از اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ارزﯾﺎﺑﯽ ﯾﺎﻓﺘﻪ ﻫﺎ ي ﺑﺎﻟﯿﻨﯽ ﺗﺴﺖ ﻫﺎي آزﻣﺎﯾﺸﮕﺎﻫﯽ، ﮐﻠﻮﻧﯿﺰاﺳﯿﻮن ﺑﺎﮐﺘﺮﯾﺎﯾﯽ و ﻣﻘﺎوﻣﺖ داروﯾﯽ در ﮐﻮدﮐﺎن و ﺑﺎﻟﻐﯿﻦ ﺟﻮان ﻣﺒﺘﻼ ﺑﻪ ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ ﺑﺴﺘﺮي در ﺑﺨﺶ ﮐﻮدﮐﺎن ﺑﯿﻤﺎرﺳﺘﺎن دﮐﺘﺮ ﻣﺴﯿﺢ داﻧﺸﻮري ﺗﻬﺮان در ﻃﯽ ﺳﺎل ﻫﺎي 2011-2006 ﺑﻮد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﯽ ﺑﺮ روي 23 ﮐﻮدك و ﺑﺎﻟﻎ ﺟﻮان ﻣﺒﺘﻼ ﺑﻪ ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ ﺷﺎﻣﻞ 12 ﺑﯿﻤﺎر دﺧﺘﺮ )52/2%( و 11 ﺑﯿﻤﺎر ﭘﺴﺮ )47/8%( اﻧﺠﺎم ﮔﺮﻓﺖ. ﺑﯿﻤﺎران ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ 6/7 ± 14/5 داﺷﺘﻨﺪ. ﮐﺸﺖ ﺧﻠﻂ 10 ﺑﯿﻤﺎر )43/5%(، ﺷﺎﻣﻞ 5 دﺧﺘﺮ )8/3%( و 5 ﭘﺴﺮ )45/5%(، از ﻧﻈﺮ ﺳﻮدوﻣﻮﻧﺎس آﺋﺮوژﯾﻨﻮزا و 2 ﺑﯿﻤﺎر )8/7%(، ﺷﺎﻣﻞ ﯾﮏ ﭘﺴﺮ )9/1%( و ﯾﮏ دﺧﺘﺮ )8/3%( از ﻧﻈﺮ اﺳﺘﺎف آرﺋﻮس ﻣﺜﺒﺖ ﮔﺰارش ﮔﺮدﯾﺪ. ﻫﻤﭽﻨﯿﻦ 2 ﺑﯿﻤﺎر دﯾﮕﺮ )8/7%( از ﻧﻈﺮ ﻣﯿﮑﻮﺑﺎﮐﺘﺮﯾﻮم ﻫﺎي ﻏﯿﺮ ﺗﻮﺑﺮﮐﻠﻮزﯾﺲ ﻣﺜﺒﺖ ﺑﻮدﻧﺪ. آزﻣﻮن ﭘﻮﺳﺘﯽ ﺗﻮﺑﺮﮐﻮﻟﯿﻦ در 10 ﺑﯿﻤﺎر ﭘﺴﺮ )46%( و 12 ﺑﯿﻤﺎر دﺧﺘﺮ )55%( ﻣﻨﻔﯽ ﮔﺰارش ﮔﺮدﯾﺪ. ﺑﺮ اﺳﺎس آﻧﺘﯽﺑﯿﻮﮔﺮام ﺑﻪ دﺳﺖ آﻣﺪه از ﮐﺸﺖ ﺧﻠﻂ ﺑﯿﻤﺎران، ﺳﻮدوﻣﻮﻧﺎس آﺋﺮوژﯾﻨﻮزا ﺑﺎﻻﺗﺮﯾﻦ ﺣﺴﺎﺳﯿﺖ داروﯾﯽ را ﻧﺴﺒﺖ ﺑﻪ ﺳﯿﭙﺮوﻓﻠﻮﮐﺴﺎﺳﯿﻦ )71/4%(، ﺳﭙﺲ آﻣﯿﮑﺎﺳﯿﻦ )50%(، ﺳﻔﺘﺎزﯾﺪﯾﻢ )30%( و ﺳﻔﺘﺮﯾﺎﮐﺴﻮن )18%( داﺷﺖ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺷﯿﻮع ﺳﺎﻻﻧﻪ ﻋﻔﻮﻧﺖ ﻫﺎي رﯾﻮي در ﺑﯿﻤﺎراﻧﯽ ﮐﻪ آﻧﺘﯽ ﺑﯿﻮﺗﯿﮏ ﭘﺮوﻓﯿﻼﮐﺴﯽ ﻧﺒﻮﻻﯾﺰ ﺷﺪه درﯾﺎﻓﺖ ﮐﺮده اﻧﺪ ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري ﭘﺎﯾﯿﻦ ﺗﺮ از ﺑﯿﻤﺎراﻧﯽ ﺑﻮد ﮐﻪ اﯾﻦ درﻣﺎن ﭘﯿﺸﮕﯿﺮاﻧﻪ را درﯾﺎﻓﺖ ﻧﻨﻤﻮدهاﻧﺪ )P<0/05(. ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﭘﯿﺸﻨﻬﺎد ﻣﯽ ﮐﻨﺪ ﮐﻪ ﻣﺼﺮف داروﻫﺎي اﺳﺘﻨﺸﺎﻗﯽ ﺟﻬﺖ ﭘﺮوﻓﯿﻼﮐﺴﯽ در ﺑﯿﻤﺎران ﻓﯿﺒﺮوز ﮐﯿﺴﺘﯿﮏ ﻣﯽ ﺗﻮاﻧﺪ ﻣﯿﺰان ﺑﺴﺘﺮي ﺷﺪن و ﻋﻮارض ﻣﺮﺑﻮط ﺑﻪ ﺑﯿﻤﺎري را ﮐﺎﻫﺶ دﻫﺪ.

Cystic fibrosis (CF) is an autosomal recessive genetic disease. A mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene caused impaired transport of chloride ions across the cell membrane. The most common microorganisms, identified in the cultures of respiratory secretions, are Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia; recurrent infections by these microorganisms are associated with morbidity and mortality of CF patients. Severe inflammation of airways is the main cause of destruction and bronchiectasis, which may result in respiratory failure in these patients. The aim of this study was monitoring the clinical findings of laboratory tests, bacterial colonization, and antibiogram in CF patients at the Pediatric Pulmonary Department of Masih Daneshvari Hospital (Tehran, Iran) between 2006 and 2011. This cross-sectional study was on 23 children and young adults with CF, including 12 (52.2%) female and 11 (47.8%) male. The patients had a mean age of 14.5 ± 6.7 years. The sputum cultures of 10 patients (43.5%), including 5 female (41.7%) and 5 male (45.5%) were positive for P. aeruginosa. Also, in 2 cases (8.7%) it was positive for S. aureus, including 1 female (8.3%) and 1 male (9.1%). The sputum cultures of 2 other patients (8.7%) were positive for nontuberculous mycobacteria (NTM). The purified protein derivative (PPD) skin test were negative in 10 male (46%) and 12 female (55%). Based on the antibiograms obtained from sputum cultures, we found that P. aeruginosa had the highest susceptibility to ciprofloxacin (71.4%), followed by amikacin (50%), ceftazidime (30%), and ceftriaxone (18%). In this study, the prevalence of respiratory infections in patients who did not received prophylactic nebulized antibiotic was significantly higher than those patients who receive them (P < 0.05). The results showed that prescription of prophylactic nebulized antibiotics in CF patients decreased the rate of admissions and complications of the patients.