Tumbarello Mario, Citton Rita, Spanu Teresa, Sanguinetti Maurizio, Romano Lucio, Fadda Giovanni, Cauda Roberto
Departments of Infectious Diseases and Microbiology, Università Cattolica, Largo A. Gemelli 8, 00168 Roma, Italy.
J Antimicrob Chemother. 2004 Feb;53(2):277-82. doi: 10.1093/jac/dkh047. Epub 2003 Dec 19.
To investigate the epidemiological and clinical findings of extended-spectrum beta-lactamase (ESBL)-producing Providencia stuartii infections in a large Italian university hospital.
All consecutive episodes of P. stuartii infection that occurred during 1999-2002 were included in the study. For each patient, we recorded the area of hospitalization and drug susceptibility of the P. stuartii strains. Patients with ESBL-producing P. stuartii infection were considered cases and those with non-ESBL-producing P. stuartii infection were used as controls.
One hundred and sixteen (52%) out of 223 P. stuartii strains collected during the study period were found to be ESBL-producing. On the basis of PCR and DNA sequencing experiments, TEM-52 was identified in 87% of isolates and TEM-72 in 13%. All ESBL-producing P. stuartii infections were nosocomially acquired. The prevalence increased from 31% of P. stuartii infections in 1999 to 62% in 2002 (P = 0.04). All 116 strains were classified as ESBL-producing multidrug-resistant P. stuartii, since 88% of the isolates were cross-resistant to ciprofloxacin and amikacin and the other 12% were cross-resistant to ciprofloxacin and gentamicin. At logistic regression analysis, advanced age (P < 0.001), previous hospitalization (P < 0.01), neoplastic disease (P < 0.001) and previous antibiotic therapy (P < 0.001) were independent risk factors for the development of ESBL-producing infections.
This 4 year surveillance of Providencia complaints clearly indicates that infections caused by ESBL-producing multidrug-resistant P. stuartii are an emerging problem.
调查意大利一家大型大学医院中产超广谱β-内酰胺酶（ESBL）的斯氏普罗威登斯菌感染的流行病学和临床特征。
纳入1999年至2002年期间所有连续发生的斯氏普罗威登斯菌感染病例。对于每位患者，我们记录了住院区域以及斯氏普罗威登斯菌菌株的药敏情况。产ESBL的斯氏普罗威登斯菌感染患者被视为病例组，非产ESBL的斯氏普罗威登斯菌感染患者作为对照组。
在研究期间收集的223株斯氏普罗威登斯菌中，有116株（52%）被发现产ESBL。基于聚合酶链反应（PCR）和DNA测序实验，87%的分离株鉴定为TEM-52，13%为TEM-72。所有产ESBL的斯氏普罗威登斯菌感染均为医院获得性感染。其患病率从1999年斯氏普罗威登斯菌感染的31%上升至2002年的62%（P = 0.04）。所有116株菌株均被归类为产ESBL的多重耐药斯氏普罗威登斯菌，因为88%的分离株对环丙沙星和阿米卡星交叉耐药，另外12%对环丙沙星和庆大霉素交叉耐药。在逻辑回归分析中，高龄（P < 0.001）、既往住院史（P < 0.01）、肿瘤性疾病（P < 0.001）和既往抗生素治疗史（P < 0.001）是产ESBL感染发生的独立危险因素。
对普罗威登斯菌感染进行的这4年监测清楚地表明，产ESBL的多重耐药斯氏普罗威登斯菌引起的感染是一个新出现的问题。
