Infectious Disease Department, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 l'Hospitalet de Llobregat, Barcelona, Spain.
J Antimicrob Chemother. 2010 Feb;65(2):333-41. doi: 10.1093/jac/dkp411. Epub 2009 Dec 3.
To assess the clinical features, risk factors, molecular epidemiology and outcome of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteraemia in hospitalized cancer patients.
Episodes of ESBL-EC bacteraemia were compared with a susceptible control group in a 3 year prospective study. ESBL-EC strains were studied by PCR and isoelectric focusing, and molecular typing was performed by PFGE.
Out of 531 episodes of bacteraemia, 135 were caused by E. coli. Seventeen of these cases involved ESBL-EC-producing strains (12.6%). In the multivariate analysis, female gender [odds ratio (OR) 3.43; 95% confidence interval (CI) 1.03-11.4] and previous antibiotic therapy (OR 3.22; 95% CI 1.00-10.3) were found to be independent risk factors for ESBL acquisition. An analysis of ESBL-EC isolates revealed a polyclonal distribution with CTX-M predominance (59%). Patients with ESBL-EC bacteraemia were more likely to have received an inadequate empirical antibiotic therapy (65% versus 6%; P = 0.000), and the time to adequate therapy was longer in this group (0 versus 1.50 days; P = 0.000). The overall mortality rate was 22%, ranging from 20% to 35% (P = 0.20). Risk factors for mortality were solid tumour (OR 19.41; 95% CI 4.66-80.83), corticosteroid therapy (OR 3.04 95% CI 1.05-8.81) and intensive care unit admission (OR 248.24, 95% CI 18.49-3332.14). In neutropenic patients, ESBL-EC bacteraemia was associated with poorer outcome and a higher overall mortality rate (37.5% versus 6.5%; P = 0.01).
In our centre, ESBL-EC bacteraemia is frequent among cancer patients, especially in those exposed to antibiotic pressure. All ESBL-EC strains were unrelated and most of them carried a CTX-M group enzyme. Patients with ESBL-EC bacteraemia received inadequate empirical antibiotic therapy more frequently than patients carrying a susceptible strain, but significant differences in mortality could not be demonstrated.
评估住院癌症患者中产超广谱β-内酰胺酶（ESBL）大肠埃希菌（ESBL-EC）菌血症的临床特征、危险因素、分子流行病学和结局。
在一项为期 3 年的前瞻性研究中，将 ESBL-EC 菌血症发作与敏感对照组进行比较。通过 PCR 和等电聚焦研究 ESBL-EC 菌株，并通过 PFGE 进行分子分型。
531 例菌血症中，135 例由大肠埃希菌引起。其中 17 例为产 ESBL-EC 的菌株（12.6%）。多变量分析发现，女性（比值比[OR]3.43；95%置信区间[CI]1.03-11.4）和先前的抗生素治疗（OR 3.22；95%CI 1.00-10.3）是 ESBL 获得的独立危险因素。对 ESBL-EC 分离株的分析显示，存在以 CTX-M 为主的多克隆分布（59%）。产 ESBL-EC 菌血症患者更可能接受不适当的经验性抗生素治疗（65%比 6%；P=0.000），且该组的适当治疗时间更长（0 天比 1.50 天；P=0.000）。总死亡率为 22%，范围为 20%至 35%（P=0.20）。死亡率的危险因素为实体瘤（OR 19.41；95%CI 4.66-80.83）、皮质类固醇治疗（OR 3.04；95%CI 1.05-8.81）和重症监护病房入住（OR 248.24；95%CI 18.49-3332.14）。在中性粒细胞减少症患者中，产 ESBL-EC 菌血症与较差的结局和更高的总体死亡率相关（37.5%比 6.5%；P=0.01）。
在我们的中心，癌症患者中 ESBL-EC 菌血症很常见，尤其是在那些暴露于抗生素压力下的患者。所有 ESBL-EC 菌株均无相关性，其中大多数携带 CTX-M 组酶。产 ESBL-EC 菌血症患者比携带敏感株的患者更常接受不适当的经验性抗生素治疗，但死亡率无显著差异。
