Pitout Johann D D, Laupland Kevin B
Division of Microbiology, Calgary Laboratory Services, Department of Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
Lancet Infect Dis. 2008 Mar;8(3):159-66. doi: 10.1016/S1473-3099(08)70041-0.
The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.
医学界依靠临床专业知识和已发布的指南，来协助医生针对基于系统的感染综合征（如社区获得性肺炎和尿路感染（UTIs））进行经验性治疗选择。自20世纪90年代末以来，产生超广谱β-内酰胺酶（ESBLs）（如CTX-M酶）的多重耐药肠杆菌科细菌（主要是大肠杆菌），已在社区环境中出现，成为尿路感染的一个重要原因。最近的报告也将产ESBL的大肠杆菌描述为与这些社区起病的尿路感染相关的血流感染的一个病因。碳青霉烯类药物被广泛认为是治疗由产ESBL的肠杆菌科细菌引起的严重感染的首选药物，尽管比较临床试验很少。因此，需要对产ESBL细菌进行更快速的诊断检测，并可能修改与尿路感染相关的社区起病菌血症的指南。
