Briggs Simon, Ussher James, Taylor Susan
Department of Infectious Diseases, Middlemore Hospital, Auckland.
N Z Med J. 2005 Jul 15;118(1218):U1563.
To review patients colonised or infected with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) at Middlemore Hospital, Auckland, New Zealand.
All patients who had an ESBLPE isolated at the Middlemore Hospital Microbiology Laboratory from January 2001 to June 2004 were included in this review.
ESBLPE were isolated from 132 patients during the review period. There were 12 patients colonised or infected with an ESBLPE in 2001, 34 in 2002, 43 in 2003, and 43 in the first 6 months of 2004. The isolates were Escherichia coli (n=56), Enterobacter spp. (n=55), and Klebsiella pneumoniae (n=21). ESBLPE were isolated from a wide range of specimens including peripheral blood in 18 patients. Thirty-three (25%) patients had an ESBLPE isolated within 48 hours of admission; seven of these patients were neither long-term care facility (LTCF) residents nor had hospital admissions in the previous 6 months. Thirty-one patients (23%) resided in a LTCF before their admission; four patients from the same LTCF had indistinguishable isolates. All isolates tested were susceptible to meropenem and imipenem. All but one isolate tested was susceptible to ertapenem, and all but two were susceptible to amikacin.
Colonisation and infection due to ESBLPE are increasing at Middlemore Hospital and in the Auckland community. We expect this trend to continue. There is evidence to suggest transmission of ESBLPE both in the Auckland community and LTCFs. Antibiotics useful for treatment of patients with proven ESBLPE infection at Middlemore Hospital include amikacin or a carbapenem. Careful infection control practices and antibiotic prescribing will be necessary to reduce the rate of increase of ESBLPE colonisation and infection at Middlemore Hospital and in the Auckland community.
对新西兰奥克兰米德尔莫尔医院中携带或感染产超广谱β-内酰胺酶肠杆菌科细菌（ESBLPE）的患者进行回顾性研究。
纳入2001年1月至2004年6月期间在米德尔莫尔医院微生物实验室分离出ESBLPE的所有患者。
在研究期间，从132例患者中分离出ESBLPE。2001年有12例患者携带或感染ESBLPE，2002年为34例，2003年为43例，2004年前6个月为43例。分离出的菌株包括大肠埃希菌（n = 56）、肠杆菌属（n = 55）和肺炎克雷伯菌（n = 21）。ESBLPE从多种标本中分离得到，包括18例患者的外周血。33例（25%）患者在入院48小时内分离出ESBLPE；其中7例患者既不是长期护理机构（LTCF）的居民，也没有在过去6个月内入院。31例（23%）患者在入院前居住在LTCF；来自同一LTCF的4例患者分离出难以区分的菌株。所有测试的分离株对美罗培南和亚胺培南敏感。除1株外，所有测试的分离株对厄他培南敏感，除2株外，所有分离株对阿米卡星敏感。
米德尔莫尔医院及奥克兰社区中ESBLPE的定植和感染正在增加。我们预计这种趋势将持续。有证据表明ESBLPE在奥克兰社区和LTCF中均有传播。对米德尔莫尔医院确诊为ESBLPE感染的患者有效的治疗抗生素包括阿米卡星或碳青霉烯类。为降低米德尔莫尔医院及奥克兰社区中ESBLPE定植和感染的增加率，需要谨慎实施感染控制措施并合理使用抗生素。
