添加克霉唑可减少但不能消除犬外耳炎有效抗菌治疗期间的真菌菌群失调。
The addition of clotrimazole reduces but does not abrogate fungal dysbiosis during effective antibacterial therapy for canine otitis externa.
文献信息
| PMID | 42791227 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | G Gallow |
| 作者单位 | Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK. |
| 期刊 | The Journal of small animal practice |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的：
马色拉菌菌群失调常发生于犬细菌性外耳炎成功接受哌拉西林-他唑巴坦单药治疗后。本研究目的是比较接受哌拉西林-他唑巴坦联合抗真菌药克霉唑治疗的犬外耳炎抗菌结局与既往仅接受哌拉西林-他唑巴坦治疗队列的差异。
材料与方法：
21只患细菌性外耳炎的犬接受局部哌拉西林-他唑巴坦（1 mL）治疗，每12小时一次，但每48小时周期中的第4剂替换为1%克霉唑溶液（1 mL）。在第1次（V1）和第2次（V2）访视时，将耳拭子尖端在PBS + Triton X-100中洗涤，并将系列稀释液涂布于血琼脂、MacConkey琼脂（37°C，48小时）和改良Dixon琼脂（32°C，14天），以生成半定量计数。微生物通过表型和MALDI-TOF进行鉴定。结局与既往仅接受哌拉西林-他唑巴坦治疗的14只犬进行比较（序贯病例-队列设计）。
结果：
在接受哌拉西林-他唑巴坦-克霉唑治疗的犬中（3/21），治疗后细菌培养计数超过零的相对风险，与仅接受哌拉西林-他唑巴坦治疗者（2/14）相比为1.00（95%置信区间0.19至5.24）。仅接受哌拉西林-他唑巴坦治疗的犬（14/14）中酵母培养计数增加的相对风险，与接受哌拉西林-他唑巴坦-克霉唑治疗的犬（7/21）相比为3.00（95%置信区间1.64至5.49）。仅接受哌拉西林-他唑巴坦治疗的犬（14/14）中真菌菌群失调（V2酵母计数 > 正常）的相对风险，与接受哌拉西林-他唑巴坦-克霉唑治疗的犬（4/21）相比为5.25（95%置信区间2.17至12.68）。
临床意义：
哌拉西林-他唑巴坦-克霉唑在治疗难治性细菌性外耳炎方面高度有效；加入克霉唑可显著减少但不能消除真菌菌群失调。
英文摘要
OBJECTIVES: Malassezia dysbiosis commonly occurs after successful piperacillin-tazobactam monotherapy for canine bacterial otitis externa. The study objective was to compare antimicrobial outcomes in dogs with otitis treated with piperacillin-tazobactam in combination with the antifungal drug clotrimazole with a previous cohort treated with piperacillin-tazobactam alone.
MATERIALS AND METHODS: Twenty-one dogs with bacterial otitis were treated topically with piperacillin-tazobactam (1 mL) every 12 hours, although the fourth dose in each 48 hours period was replaced with 1% clotrimazole solution (1 mL). At visits 1 (V1) and 2 (V2), ear swab tips were washed in PBS + Triton X-100 and serial dilutions spread-plated onto blood, MacConkey (37°C, 48 hours) and modified Dixon's agar (32°C, 14 days) to generate semiquantitative counts. Microbes were identified by phenotype and MALDI-TOF. Outcomes were compared with those of 14 dogs previously treated with piperacillin-tazobactam alone (sequential case-cohort design).
RESULTS: Relative risk of a post-treatment bacterial culture count exceeding zero in dogs treated with piperacillin-tazobactam-clotrimazole (3/21), when compared to piperacillin-tazobactam treatment alone (2/14) was 1.00 (95% confidence interval 0.19 to 5.24). Relative risk of an increase in yeast culture count in dogs treated with piperacillin-tazobactam alone (14/14), when compared to piperacillin-tazobactam-clotrimazole-treated dogs (7/21), was 3.00 (95% confidence interval 1.64 to 5.49). Relative risk of fungal dysbiosis (V2 yeast count > normal) in dogs treated with piperacillin-tazobactam alone (14/14), when compared to piperacillin-tazobactam-clotrimazole-treated dogs (4/21), was 5.25 (95% CI 2.17 to 12.68).
CLINICAL SIGNIFICANCE: Piperacillin-tazobactam-clotrimazole is highly efficacious in the treatment of refractory bacterial otitis; incorporation of clotrimazole markedly reduces but does not abrogate fungal dysbiosis.