Harris Anthony D, McGregor Jessina C, Johnson Judith A, Strauss Sandra M, Moore Anita C, Standiford Harold C, Hebden Joan N, Morris J Glenn
Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore 21201, USA.
Emerg Infect Dis. 2007 Aug;13(8):1144-9. doi: 10.3201/eid1308.070071.
Extended-spectrum beta-lactamase (ESBL)-producing bacteria are emerging pathogens. To analyze risk factors for colonization with ESBL-producing bacteria at intensive care unit (ICU) admission, we conducted a prospective study of a 3.5-year cohort of patients admitted to medical and surgical ICUs at the University of Maryland Medical Center. Over the study period, admission cultures were obtained from 5,209 patients. Of these, 117 were colonized with ESBL-producing Escherichia coli and Klebsiella spp., and 29 (25%) had a subsequent ESBL-positive clinical culture. Multivariable analysis showed the following to be statistically associated with ESBL colonization at admission: piperacillin-tazobactam (odds ratio [OR] 2.05, 95% confidence interval [CI] 1.36-3.10), vancomycin (OR 2.11, 95% CI 1.34-3.31), age > 60 years (OR 1.79, 95% CI 1.24-2.60), and chronic disease score (OR 1.15; 95% CI 1.04-1.27). Coexisting conditions and previous antimicrobial drug exposure are thus predictive of colonization, and a large percentage of these patients have subsequent positive clinical cultures for ESBL-producing bacteria.
产超广谱β-内酰胺酶（ESBL）细菌正成为新兴病原体。为分析重症监护病房（ICU）入院时产ESBL细菌定植的风险因素，我们对马里兰大学医学中心内科和外科ICU收治的患者进行了一项为期3.5年的前瞻性队列研究。在研究期间，从5209例患者中获取了入院时的培养样本。其中，117例患者被产ESBL的大肠杆菌和克雷伯菌属定植，29例（25%）随后临床培养结果为ESBL阳性。多变量分析显示，以下因素与入院时ESBL定植在统计学上相关：哌拉西林-他唑巴坦（比值比[OR]2.05，95%置信区间[CI]1.36 - 3.10）、万古霉素（OR 2.11，95% CI 1.34 - 3.31）、年龄>60岁（OR 1.79，95% CI 1.24 - 2.60）以及慢性病评分（OR 1.15；95% CI 1.04 - 1.27）。因此，共存疾病和既往抗菌药物暴露可预测定植情况，并且这些患者中有很大比例随后临床培养结果为产ESBL细菌阳性。
