Chayakulkeeree Methee, Junsriwong Pichai, Keerasuntonpong Anuwat, Tribuddharat Chanwit, Thamlikitkul Visanu
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health. 2005 Nov;36(6):1503-9.
A cross-sectional study was conducted from August to September, 2003 to determine the prevalence and risk factors in acquiring extended-spectrum beta-lactamase (ESBL) producing gram-negative bacilli (GNB) in patients admitted to Siriraj Hospital and the outcomes of these infections. Of 346 isolates of gram-negative bacteria in 249 patients, 102 isolates from 87 patients were colonization only, but 244 isolates from 162 patients were infections. The common GNB were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. The overall prevalence of ESBL producers was 30.1%. K. pneumoniae had a very high prevalence of ESBL producers (56.9%). The urinary tract was the most common site for ESBL- producing GNB infections. Nosocomial infections, duration from admission to infection, peripheral line, urinary catheterization, nasogastric tube insertion and previous use of beta-lactams, cephalosporins and fluoroquinolones were associated with acquiring ESBL-producing GNB infections. ESBL-producing GNB were significantly more resistant to antimicrobial agents. More than 80% of ESBL-producing GNB were susceptible to carbapenems. Mortality in patients infected with ESBL-producing GNB (41.3%) was significantly higher than those infected with non- ESBL-producing GNB (19.8%).
2003年8月至9月开展了一项横断面研究，以确定诗里拉吉医院收治患者中产超广谱β-内酰胺酶（ESBL）革兰阴性杆菌（GNB）的感染率、危险因素及其感染后果。在249例患者的346株革兰阴性菌分离株中，87例患者的102株分离株仅为定植菌，但162例患者的244株分离株为感染菌。常见的GNB包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌。产ESBL菌的总体感染率为30.1%。肺炎克雷伯菌中产ESBL菌的感染率非常高（56.9%）。泌尿道是产ESBL的GNB感染最常见的部位。医院感染、入院至感染的持续时间、外周静脉置管、导尿、鼻胃管插入以及既往使用β-内酰胺类、头孢菌素类和氟喹诺酮类药物与产ESBL的GNB感染有关。产ESBL的GNB对抗菌药物的耐药性明显更高。超过80%的产ESBL的GNB对碳青霉烯类药物敏感。产ESBL的GNB感染患者的死亡率（41.3%）明显高于非产ESBL的GNB感染患者（19.8%）。
