产超广谱β-内酰胺酶表型预示着对头孢泊肟耐药的大肠埃希菌或肺炎克雷伯菌菌血症患者预后不良。

Extended-spectrum beta-lactamase-producing phenotype signifies a poor prognosis for patients with cefpodoxime-resistant Escherichia coli or Klebsiella pneumoniae bacteremia.

机构信息

Department of Internal Medicine, National Cheng Kung University Hospital, 704 Tainan, Taiwan.

出版信息

J Microbiol Immunol Infect. 2009 Aug;42(4):303-9.

PMID:19949753

Abstract

BACKGROUND AND PURPOSE

Bloodstream infections caused by multidrug-resistant Enterobacteriaceae are a major concern. This study explored the clinical impact of extended-spectrum beta-lactamase (ESBL) production among cefpodoxime-resistant Escherichia coli and Klebsiella pneumoniae bacteremia.

METHODS

The medical charts and microbiological results of patients with cefpodoxime-resistant E. coli or K. pneumoniae bacteremia in a tertiary hospital in southern Taiwan between June 2003 and December 2006 were retrospectively reviewed. The clinical characteristics, medical histories, and clinical outcomes were evaluated. ESBL production was indicated by the double-disk synergy test.

RESULTS

278 episodes of bacteremia caused by cefpodoxime-resistant K. pneumoniae or E. coli were identified, of which 115 (41%) were ESBL producing. Compared with non-ESBL-producing bacteremia, bacteremic episodes caused by ESBL producers were less often community acquired (4.3% vs 26.4%; p < 0.001). Underlying diabetes mellitus (48.7% vs 35.0%; p = 0.02), liver cirrhosis (22.6% vs 11.7%; p = 0.02), or uremia (21.7% vs 3.7%; p < 0.001) were more common in ESBL-producing bacteremia. In contrast, solid tumors were more frequent in non-ESBL-producing bacteremia (44.8% vs 27.8%; p = 0.004). Overall, patients with ESBL-producing bacteremia had higher disease severity indicated by a Pittsburgh bacteremia score > or = 4, longer duration of hospital stay (51.1 days vs 31.9 days; p = 0.007), more admission to intensive care units (19.1% vs 8.0%; p = 0.006), and a higher mortality rate at 28 days (34.8% vs 23.9%; p = 0.03).

CONCLUSIONS

ESBL production signifies a poor clinical outcome for patients with bacteremia caused by cefpodoxime-resistant E. coli or K. pneumoniae.

摘要

背景与目的

血流感染由多重耐药肠杆菌科细菌引起是一个主要关注点。本研究探讨了头孢泊肟耐药大肠埃希菌和肺炎克雷伯菌菌血症中产超广谱β-内酰胺酶（ESBL）的临床影响。

方法

回顾性分析了 2003 年 6 月至 2006 年 12 月台湾南部一家三级医院头孢泊肟耐药大肠埃希菌或肺炎克雷伯菌菌血症患者的病历和微生物学结果。评估了临床特征、病史和临床结局。ESBL 的产生通过双碟协同试验来指示。

结果

共确定了 278 例头孢泊肟耐药肺炎克雷伯菌或大肠埃希菌引起的菌血症，其中 115 例（41%）产 ESBL。与非 ESBL 产菌血症相比，ESBL 产菌血症的社区获得性感染较少（4.3% vs. 26.4%；p<0.001）。潜在的糖尿病（48.7% vs. 35.0%；p=0.02）、肝硬化（22.6% vs. 11.7%；p=0.02）或尿毒症（21.7% vs. 3.7%；p<0.001）在 ESBL 产菌血症中更为常见。相反，非 ESBL 产菌血症中更常见实体肿瘤（44.8% vs. 27.8%；p=0.004）。总体而言，ESBL 产菌血症患者的疾病严重程度更高，表现为匹兹堡菌血症评分≥4（34.8% vs. 23.9%；p=0.03），住院时间更长（51.1 天 vs. 31.9 天；p=0.007），入住重症监护病房的比例更高（19.1% vs. 8.0%；p=0.006），28 天死亡率更高（34.8% vs. 23.9%；p=0.03）。