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Relevância clínica de small colony variants de Staphylococcus aureus
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SCV S. aureus constitui uma subpopulação de S. aureus com características fenotípicas distintas, tendo sido recentemente associado a infeções crónicas e resposta insatisfatória à terapêutica. Com o objetivo de determinar o real impacto clínico SCV S. aureus, identificar a população em risco, analisar os métodos de isolamento e o melhor tratamento procedeu-se a uma revisão da literatura disponível, com destaque à relevância clínica de SCV S. aureus.
Foram identificados um total de 46 artigos clínicos, dos quais 27 comunicações originais e 19 com casos clínicos, e 6 artigos de revisão sobre o tema.
Através desta análise, foi possível verificar a associação frequente de SCV S. aureus a infeções de dispositivos médicos. Em termos de métodos de identificação, verificou-se uma elevada necessidade de utilização de meios de cultura suplementados para identificar SCV S. aureus (51% dos casos clínicos e 100% das séries de doentes), bem como uma elevada utilização de métodos moleculares (em 50% dos casos clínicos e séries de doentes). Relativamente à terapêutica foi possível verificar uma elevada taxa de insucesso terapêutico (20%), bem como a necessidade frequente de utilização de antibioticoterapia combinada para atingir sucesso terapêutico. Verificou-se também que, quando este tipo de infeção se associava a dispositivos médicos, a sua remoção era frequentemente necessária – 89% dos casos. Constatou-se uma grande associação entre a presença de SCV S. aureus em doentes com fibrose quística e a diminuição da função pulmonar.
Assim, foi possível concluir que infeções por SCV S. aureus têm uma relevância clínica importante, particularmente em infeções associadas a dispositivos e em infeções crónicas, com relevância epidemiológica e elevada dificuldade de deteção e tratamento. Por esta razão, parece importante considerar SCV S. aureus em infeções crónicas, especialmente se o tratamento indicado não teve sucesso.
SCV S. aureus represents a subpopulation of S. aureus with distinct phenotypic characteristics, which recently was associated with chronic infections and unsatisfactory response to therapy. In order to determine the clinical impact of SCV S. aureus, identify the population at risk, determine the best microbiologic methods for identification and the optimized treatment, we proposed a review of all available literature, with emphasis towards clinical relevance of SCV S. aureus. A total of 46 clinical articles were identified, of which 27 were original communications and 19 were clinical cases. Further 6 review-articles on the subject were consultated. By this analysis, it was possible to verify a frequent association between SCV S. aureus and medical device infections. In terms of identification methods, there was a high need to use supplemented culture media to identify SCV S. aureus (51% of the clinical cases and 100% of the patient series), as well as a high use of molecular methods (in 50% of clinical cases and patient series). Regarding therapy, it was possible to verify a high rate of therapeutic failure (20%) as well as the frequent need of using combined antibiotic therapy to achieve therapeutic success. It was also found that, when this type of infection was associated with medical devices, its removal was often necessary – 89% of the cases. A great association was found between the presence of SCV S. aureus in patients with cystic fibrosis and decreased lung function. Thus, it was possible to conclude that infections by SCV S. aureus have an important clinical relevance, particularly in infections associated with devices and in chronic infections, with epidemiological relevance and high difficulty in detection and treatment. Therefore, it seems important to consider SCV S. aureus in chronic infections and especially if the indicated treatment was unsuccessful.
SCV S. aureus represents a subpopulation of S. aureus with distinct phenotypic characteristics, which recently was associated with chronic infections and unsatisfactory response to therapy. In order to determine the clinical impact of SCV S. aureus, identify the population at risk, determine the best microbiologic methods for identification and the optimized treatment, we proposed a review of all available literature, with emphasis towards clinical relevance of SCV S. aureus. A total of 46 clinical articles were identified, of which 27 were original communications and 19 were clinical cases. Further 6 review-articles on the subject were consultated. By this analysis, it was possible to verify a frequent association between SCV S. aureus and medical device infections. In terms of identification methods, there was a high need to use supplemented culture media to identify SCV S. aureus (51% of the clinical cases and 100% of the patient series), as well as a high use of molecular methods (in 50% of clinical cases and patient series). Regarding therapy, it was possible to verify a high rate of therapeutic failure (20%) as well as the frequent need of using combined antibiotic therapy to achieve therapeutic success. It was also found that, when this type of infection was associated with medical devices, its removal was often necessary – 89% of the cases. A great association was found between the presence of SCV S. aureus in patients with cystic fibrosis and decreased lung function. Thus, it was possible to conclude that infections by SCV S. aureus have an important clinical relevance, particularly in infections associated with devices and in chronic infections, with epidemiological relevance and high difficulty in detection and treatment. Therefore, it seems important to consider SCV S. aureus in chronic infections and especially if the indicated treatment was unsuccessful.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Staphylococcus aureus Small colony variants of Staphylococcus aureus Detecção Tratamento Infecção crónica Resistência Doenças transmissíveis