Department of Infectious Diseases, Zhongshan Hospital of Fu Dan University, Shanghai, China.
Curr Med Res Opin. 2010 Jun;26(6):1443-9. doi: 10.1185/03007991003769068.
To compare clinical and economic outcomes in patients with community-acquired intra-abdominal infection (IAI) due to extended spectrum beta-lactamase (ESBL) producing (ESBL-positive) bacteria versus non-ESBL-producing (ESBL-negative) bacteria in China.
This was a retrospective chart review study of patients hospitalized with community-acquired IAI due to ESBL-positive or ESBL-negative infections caused by Escherichia coli or Klebsiella spp. Data were collected from six hospitals in China that participated in the Study for Monitoring Antibiotic Resistance Trends (SMART) during 2006-2007. Outcomes included clinical response at discharge and following first-line antibiotic, number of antibiotic agents and classes, duration of hospitalization, and overall hospitalization and intravenous antibiotic costs.
Of the 85 patients included in the study, 32 (37.6%) had ESBL-positive and 53 (62.4%) had ESBL-negative infections; E. coli was responsible for 77.6% of infections. Infection resolved at discharge in 30 (93.8%) ESBL-positive and 48 (90.6%) ESBL-negative patients (P = NS). Fewer ESBL-positive patients achieved complete response following first-line antibiotics (56.3% versus 83.0%; P = 0.01). ESBL-positive patients required longer antibiotic treatment, more antibiotics, longer hospitalization (24.3 versus 14.6 days; 1.67-fold ratio; P = 0.001), and incurred higher hospitalization costs ( yen24,604 vs. yen13,788; $3604 vs. $2020; 1.78-fold ratio; P < 0.001).
Patients with ESBL-positive infection had similar resolution rates at discharge compared to those with ESBL-negative infection, despite poorer first-line antibiotic response. However, ESBL-positive infection led to significantly greater hospitalization cost and intravenous antibiotic cost, and longer hospital stay.
比较中国产超广谱β-内酰胺酶（ESBL）阳性细菌和非产 ESBL 阴性细菌引起的社区获得性腹腔内感染（IAI）患者的临床和经济结局。
这是一项回顾性图表审查研究，纳入了 2006-2007 年在中国参与监测抗生素耐药趋势（SMART）研究的六家医院住院的社区获得性 ESBL 阳性或 ESBL 阴性大肠埃希菌或克雷伯菌引起的 IAI 患者。结果包括出院时的临床反应以及一线抗生素治疗后的反应、抗生素使用数量和种类、住院时间和总住院和静脉用抗生素费用。
研究共纳入 85 例患者，其中 32 例（37.6%）为 ESBL 阳性，53 例（62.4%）为 ESBL 阴性；感染由大肠埃希菌引起的比例为 77.6%。ESBL 阳性组 30 例（93.8%）和 ESBL 阴性组 48 例（90.6%）患者出院时感染得到解决（P = NS）。ESBL 阳性组患者一线抗生素治疗后完全缓解的比例较低（56.3% vs. 83.0%；P = 0.01）。ESBL 阳性组患者需要更长的抗生素治疗时间、更多的抗生素种类、更长的住院时间（24.3 天 vs. 14.6 天；1.67 倍；P = 0.001）和更高的住院费用（日元 24604 日元 vs. 日元 13788 日元；美元 3604 美元 vs. 美元 2020 美元；1.78 倍；P < 0.001）。
尽管 ESBL 阳性感染患者一线抗生素治疗反应较差，但与 ESBL 阴性感染患者相比，其出院时的缓解率相似。然而，ESBL 阳性感染导致住院费用和静脉用抗生素费用显著增加，住院时间延长。
