Laupland K B, Gregson D B, Church D L, Ross T, Pitout J D D
Department of Medicine, University of Calgary, Calgary, ALberta, Canada.
Clin Microbiol Infect. 2008 Nov;14(11):1041-7. doi: 10.1111/j.1469-0691.2008.02089.x.
Although Escherichia coli is the most common cause of bloodstream infection, its epidemiology has not been well defined in non-selected populations. We sought to describe the incidence of risk factors for, and outcomes associated with, E. coli bacteraemia. Population-based surveillance for E. coli bacteraemia was conducted in the Calgary Health Region (population 1.2 million) during the period 2000-2006. In total, 2368 episodes of E. coli bacteraemia were identified for an overall annual population incidence of 30.3/100 000; 15% were nosocomial, 32% were healthcare-associated community-onset and 53% were community-acquired bacteraemias. The very young and the elderly were at highest risk for E. coli bacteraemia. Sixty per cent of the episodes occurred in females (relative risk 1.5; 95% CI 1.4-1.6). Dialysis, solid organ transplantation and neoplastic disease were the most important risk factors for acquiring E. coli bacteraemia. Rates of resistance to ampicillin, trimethoprim-sulphamethoxazole, gentamicin, ciprofloxacin, cefazolin and ceftriaxone increased significantly during the period 2000-2006. The case-fatality rate was 11% and the annual population mortality rate was 2.9/100 000. Increasing age, ciprofloxacin resistance, non-urinary focus and a number of comorbid illnesses were independently associated with an increased risk of death, and community acquisition and urinary focus were associated with a lower risk of death. This study documents the major burden of illness associated with E. coli bacteraemia and identifies groups at increased risk for acquiring and dying from these infections. The emergence of ciprofloxacin resistance and its adverse effect on patient outcome is a major concern.
尽管大肠杆菌是血流感染最常见的病因，但其流行病学在未经过挑选的人群中尚未得到充分界定。我们试图描述大肠杆菌菌血症的危险因素发生率及其相关结局。2000年至2006年期间，在卡尔加里健康地区（人口120万）开展了基于人群的大肠杆菌菌血症监测。总共识别出2368例大肠杆菌菌血症发作病例，总体年人群发病率为30.3/10万；其中15%为医院感染，32%为医疗保健相关社区起病型，53%为社区获得性菌血症。年龄极小和极大的人群患大肠杆菌菌血症的风险最高。60%的发作病例发生在女性中（相对风险1.5；95%可信区间1.4 - 1.6）。透析、实体器官移植和肿瘤性疾病是获得大肠杆菌菌血症最重要的危险因素。2000年至2006年期间，对氨苄西林、复方新诺明、庆大霉素、环丙沙星、头孢唑林和头孢曲松的耐药率显著上升。病死率为11%，年人群死亡率为2.9/10万。年龄增加、对环丙沙星耐药、非泌尿道感染部位以及多种合并症与死亡风险增加独立相关，而社区获得性感染和泌尿道感染部位与死亡风险较低相关。本研究记录了与大肠杆菌菌血症相关的主要疾病负担，并确定了感染和死于这些感染风险增加的人群。环丙沙星耐药性的出现及其对患者结局的不利影响是一个主要关注点。
