Gundes Sibel, Arisoy Ayse Engin, Kolayli Fetiye, Karaali Emel, Turker Gulcan, Sanic Ahmet, Arisoy Emin Sami, Vahaboglu Haluk
Infeksiyon Hastaliklari & Klinik Mikrobiyoloji AD, Kocaeli Universitesi, Kocaeli, Turkey.
New Microbiol. 2005 Jul;28(3):231-6.
An outbreak of extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae (ESBL-Kp) in a neonatal intensive care unit prompted a prospective surveillance study between 12th September and 6th October 2003. Surveillance was carried out by obtaining stool samples twice a week. The DNA relatedness of the isolates was shown by random amplified polymorphic DNA comparison (ERIC-PCR). ESBL production was identified by clavulanate synergy, isoelectric focusing, PCR and sequence analysis. During the study period, 49 neonates were hospitalized in the neonatal intensive care unit (NICU). In the first 20-day period, five neonates were infected with ESBL-Kp. The first patient treated with third generation cephalosporin and the second patient treated with meropenem died. While all three infected survivors were clinically improving, the digestive tracts were being colonized by SHV-5 producing Klebsiella. In the next period of the study, five neonates were colonized by ESBL-Kp as well. Univariate comparison of risk factors between colonized and non-colonized neonates was not significant. A total of 24 colonally related ESBL-Kp have been recovered from clinical materials and stool samples. This study demonstrated that parenterally applied meropenem, though successful in treating the systemic illness, might fail to protect the digestive tract from colonization of ESBL-Kp.
2003年9月12日至10月6日期间，一家新生儿重症监护病房爆发了产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌（ESBL-Kp）感染，为此开展了一项前瞻性监测研究。通过每周采集两次粪便样本进行监测。分离株的DNA相关性通过随机扩增多态性DNA比较（ERIC-PCR）显示。通过克拉维酸协同试验、等电聚焦、PCR和序列分析鉴定ESBL的产生情况。研究期间，49名新生儿入住新生儿重症监护病房（NICU）。在最初的20天里，有5名新生儿感染了ESBL-Kp。第一名接受第三代头孢菌素治疗的患者和第二名接受美罗培南治疗的患者死亡。虽然三名感染幸存者的临床症状均有所改善，但他们的消化道正被产SHV-5的克雷伯菌定植。在研究的下一阶段，又有5名新生儿被ESBL-Kp定植。对定植和未定植新生儿的危险因素进行单因素比较，结果无显著性差异。从临床材料和粪便样本中总共分离出24株与肠道相关的ESBL-Kp。这项研究表明，静脉注射美罗培南虽然成功治疗了全身性疾病，但可能无法保护消化道免受ESBL-Kp的定植。
