Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA.
Infect Control Hosp Epidemiol. 2010 Dec;31(12):1242-9. doi: 10.1086/657138. Epub 2010 Oct 28.
Carbapenem resistance among Enterobacteriaceae is of concern because of increasing prevalence and limited therapeutic options. Limited research has been focused on understanding ertapenem resistance as a more sensitive marker for resistance to other carbapenems. We sought to determine risk factors for acquisition of ertapenem-resistant, meropenem-susceptible, or intermediate Enterobacteriaceae and to assess associated patient outcomes.
Retrospective case-control study among adult hospitalized inpatients.
A 902-bed quaternary care urban hospital.
Sixty-two cases of ertapenem-resistant Enterobacteriaceae were identified from March 14, 2006, through October 31, 2007, and 62 unmatched control patients were randomly selected from other inpatients with cultures positive for ertapenem-susceptible Enterobacteriaceae. Thirty-seven (60%) of case patient isolates were Enterobacter cloacae, 20 (32%) were Klebsiella pneumoniae, and 5 (8%) were other species of Enterobacteriaceae. Risk factors for ertapenem-resistant Enterobacteriaceae infection included intensive care unit stay (odds ratio [OR], 4.6 [95% confidence interval {CI}, 2.0-10.3]), vancomycin-resistant Enterococcus colonization (OR, 7.1 [95% CI, 2.4-21.4]), prior central venous catheter use (OR, 10.0 [95% CI, 3.0-33.1]), prior receipt of mechanical ventilation (OR, 5.8 [95% CI, 2.1-16.2]), exposure to any antibiotic during the 30 days prior to a positive culture result (OR, 18.5 [95% CI, 4.9-69.9]), use of a β-lactam during the 30 days prior to a positive culture result (OR, 6.9 [95% CI, 3.0-16.0], and use of a carbapenem during the 30 days prior to a positive culture result (OR, 18.2 [95% CI, 2.6-130.0]). For the 62 case patients, 30-day outcomes from the time of positive culture result were 24 discharges (39%), 10 deaths (16%), and 28 continued hospitalizations (44%). The final end point of the hospitalization was discharge for 44 patients (71%) and death for 18 patients (29%).
Ertapenem-resistant Enterobacteriaceae are important nosocomial pathogens. Multiple mechanisms of resistance may be in operation. Additional study of ertapenem resistance is needed.
肠杆菌科的碳青霉烯类耐药性令人担忧，因为其流行率不断上升，而治疗选择却很有限。目前，研究主要集中在理解厄他培南耐药性作为对其他碳青霉烯类药物耐药性的更敏感标志物。我们试图确定获得厄他培南耐药、美罗培南敏感或中介的肠杆菌科的危险因素，并评估相关的患者结局。
对住院成年患者进行的回顾性病例对照研究。
一家拥有 902 张床位的四级保健城市医院。
从 2006 年 3 月 14 日至 2007 年 10 月 31 日，共发现 62 例厄他培南耐药肠杆菌科，从其他厄他培南敏感肠杆菌科培养阳性的住院患者中随机选择了 62 例未匹配的对照患者。37 例（60%）分离株为阴沟肠杆菌，20 例（32%）为肺炎克雷伯菌，5 例（8%）为其他肠杆菌科。厄他培南耐药肠杆菌科感染的危险因素包括重症监护病房入住（比值比[OR]，4.6[95%置信区间{CI}，2.0-10.3]）、万古霉素耐药肠球菌定植（OR，7.1[95%CI，2.4-21.4]）、先前使用中心静脉导管（OR，10.0[95%CI，3.0-33.1]）、先前接受机械通气（OR，5.8[95%CI，2.1-16.2]）、在阳性培养结果前 30 天内使用任何抗生素（OR，18.5[95%CI，4.9-69.9]）、在阳性培养结果前 30 天内使用β-内酰胺类药物（OR，6.9[95%CI，3.0-16.0]）和在阳性培养结果前 30 天内使用碳青霉烯类药物（OR，18.2[95%CI，2.6-130.0]）。对于这 62 例病例患者，从阳性培养结果时开始的 30 天结局为 24 例出院（39%）、10 例死亡（16%）和 28 例继续住院（44%）。最终住院结局为 44 例患者（71%）出院，18 例患者（29%）死亡。
厄他培南耐药肠杆菌科是重要的医院获得性病原体。可能存在多种耐药机制。需要进一步研究厄他培南耐药性。
