Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Eur J Clin Microbiol Infect Dis. 2011 Jan;30(1):33-9. doi: 10.1007/s10096-010-1048-2. Epub 2010 Sep 17.
To determine whether there are differences in risk factors and outcomes among patients with E. coli bacteremia caused by strains that produce CTX-M or non-CTX-M extended-spectrum beta-lactamases. From 1 July 2005 to 30 June 2007, patients with positive blood culture of extended-spectrum β-lactamases (ESBL)-producing E. coli were reviewed. Sixty patients with ESBL-producing E. coli bacteremia were identified. These included 41 (68.3%) isolates with CTX-M β-lactamases. CTX-M-14 accounted for 31 (75.6%) and CTX-M-3 for 9 (22.0%) of the 41 CTX-M isolates. Patients with CTX-M strains were less likely, by univariate analysis, to have significant risk factors for infection including age ≥ 65 years, chronic renal insufficiency, ICU stay at bacteremia onset, central venous catheter use and mechanical ventilation. Multivariate analysis revealed that chronic renal failure and ICU stay were independent predictors. Antibiograms were similar for CTX-M and non-CTX-M producers except that CTX-M strains were significantly more susceptible to cefmetazole (92.7 vs 36.8%, p < 0.0001). The overall mortality and length of hospitalization were not significantly different between the two groups. E. coli with CTX-M β-lactamases was more likely than non-CTX-M strains to invade non-compromised patients. There were no differences in clinical outcomes between the two groups.
为了确定产 CTX-M 或非 CTX-M 型扩展谱β-内酰胺酶的大肠埃希菌菌血症患者的危险因素和结局是否存在差异。在 2005 年 7 月 1 日至 2007 年 6 月 30 日期间，对产 ESBL 大肠埃希菌血培养阳性的患者进行了回顾性分析。共发现 60 例产 ESBL 大肠埃希菌菌血症患者，其中 41 例（68.3%）为 CTX-M 型β-内酰胺酶。41 株 CTX-M 型中，CTX-M-14 占 31 株（75.6%），CTX-M-3 占 9 株（22.0%）。单因素分析显示，CTX-M 株患者发生感染的危险因素较少，包括年龄≥65 岁、慢性肾功能不全、血培养发病时 ICU 入住、中心静脉导管使用和机械通气。多因素分析显示，慢性肾功能衰竭和 ICU 入住是独立的预测因素。除了 CTX-M 株对头孢美唑的敏感性显著高于非 CTX-M 株（92.7%比 36.8%，P<0.0001）外，两组的药敏谱相似。两组的总体死亡率和住院时间无显著差异。产 CTX-M 型β-内酰胺酶的大肠埃希菌比非 CTX-M 株更易侵犯非危重病患者。两组患者的临床结局无差异。
