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一项针对非住院患者感染产超广谱β-内酰胺酶肠杆菌科细菌危险因素的多国调查。

A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients.

作者信息

Ben-Ami Ronen, Rodríguez-Baño Jesús, Arslan Hande, Pitout Johann D D, Quentin Claudine, Calbo Esther S, Azap Ozlem K, Arpin Corinne, Pascual Alvaro, Livermore David M, Garau Javier, Carmeli Yehuda

机构信息

Infectious Diseases Unit and the 2Division of Epidemiology, Tel Aviv Medical Center, Tel Aviv, Israel.

出版信息

Clin Infect Dis. 2009 Sep 1;49(5):682-90. doi: 10.1086/604713.

Abstract

BACKGROUND

Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasing in frequency and are associated with high mortality rates. Circulation of CTX-M-type ESBLs in the community is of particular concern, because it may confound standard infection-control measures.

METHODS

We analyzed the results of epidemiologic studies of infection caused by ESBL-producing Enterobacteriaceae in nonhospitalized patients from 6 centers in Europe, Asia, and North America. Risk factors for infection with an ESBL-producing organism were identified by univariate and multivariate analyses.

RESULTS

A total of 983 patient-specific isolates were reviewed (890 [90.5%] of which were Escherichia coli, 68 [6.9%] of which were Klebsiella species, and 25 [2.5%] of which were Proteus mirabilis); 339 [34.5%] of the isolates produced ESBLs. CTX-M types were the most frequent ESBLs (accounting for 65%). Rates of co-resistance to ciprofloxacin among ESBL-producing isolates were high (>70%), but significant variation was seen among centers with respect to rates of resistance to gentamicin, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Similar risk factors for infection with an ESBL-producing organism were found in the different participating centers. Significant risk factors, identified by multivariate analysis, were recent antibiotic use, residence in a long-term care facility, recent hospitalization, age 65 years, and male sex (area under the receiver-operator characteristic [ROC] curve, 0.80). However, 34% of ESBL-producing isolates (115 of 336 isolates) were obtained from patients with no recent health care contact; the area under the ROC curve for the multivariate model for this group of patients was only 0.70, which indicated poorer predictive value.

CONCLUSIONS

Community-acquired ESBL-producing Enterobacteriaceae are now prevalent worldwide, necessitating international collaboration. Novel approaches are required to adequately address issues such as empirical treatment for severe community-acquired infection and infection control.

摘要

背景

产超广谱β-内酰胺酶(ESBL)肠杆菌科细菌引起的感染日益增多,且与高死亡率相关。社区中CTX-M型ESBL的传播尤为令人担忧,因为这可能会使标准感染控制措施变得复杂。

方法

我们分析了来自欧洲、亚洲和北美的6个中心的非住院患者中产ESBL肠杆菌科细菌感染的流行病学研究结果。通过单因素和多因素分析确定产ESBL生物体感染的危险因素。

结果

共审查了983株患者特异性分离株(其中890株[90.5%]为大肠埃希菌,68株[6.9%]为克雷伯菌属,25株[2.5%]为奇异变形杆菌);339株[34.5%]分离株产ESBL。CTX-M型是最常见的ESBL(占65%)。产ESBL分离株对环丙沙星的共耐药率很高(>70%),但各中心对庆大霉素、阿莫西林-克拉维酸和甲氧苄啶-磺胺甲恶唑的耐药率存在显著差异。不同参与中心发现了产ESBL生物体感染的类似危险因素。多因素分析确定的显著危险因素为近期使用抗生素、居住在长期护理机构、近期住院、年龄≥65岁和男性(受试者工作特征[ROC]曲线下面积,0.80)。然而,34%的产ESBL分离株(336株中的115株)来自近期无医疗接触的患者;该组患者多因素模型的ROC曲线下面积仅为0.70,这表明预测价值较差。

结论

社区获得性产ESBL肠杆菌科细菌目前在全球普遍存在,需要国际合作。需要新的方法来充分解决诸如严重社区获得性感染的经验性治疗和感染控制等问题。

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