Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Microbiol Immunol Infect. 2010 Jun;43(3):194-9. doi: 10.1016/S1684-1182(10)60031-X.
BACKGROUND/PURPOSE: The number of community-onset bacteremic urinary tract infections (UTIs) caused by Escherichia coli and Klebsiella pneumoniae is increasing. However, the impact of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae (ESBL-EK) on bacteremic UTI outcomes is unknown. The aim of this study was to retrospectively analyze the impact of ESBL-EK on community-onset bacteremic UTIs.
Of the 58 patients enrolled, 12 suffered from ESBL-EK-caused community-onset bacteremic UTIs. Patients were categorized into ESBL (n=12) and non-ESBL (n=46) groups. Diagnosis was based on findings of concurrent bacteremia and bacteriuria caused by the same pathogen on admission.
The ESBL group had significantly more male patients (66.7%vs. 23.9%; p=0.005), indwelling urinary catheters (41.7%vs. 6.5%; p=0.002), patients admitted from other healthcare facilities (50.0%vs. 8.7%; p=0.001), and patients with higher Acute Physiology and Chronic Health Evaluation II scores (23.3±7.1 vs. 15.9±6.3; p=0.001) and intensive care unit admissions (41.7%vs. 4.4%; p=0.003) than the non-ESBL group. Multiple logistic regression analysis revealed that male gender (odds ratio=9.2; 95%, confidence interval=1.7-50.6) and healthcare facility residency (odds ratio=15.5; 95% confidence interval=2.4-98.9) were independent risk factors for ESBL-producer infections among bacteremic UTIs. Although the mortality rate of both groups was similar (8.3%vs. 4.4%; p=0.403), the ESBL group had longer hospital stays (16.3±9.3 days vs. 7.9±5.2 days; p=0.010) and higher antibiotic costs (615.1±423.5 USD vs. 252.8±269.2 USD, p=0.014).
Male gender and healthcare facility residency are risk factors for ESBL-producer infections among patients with community-onset bacteremic UTIs. Patients with bacteremic UTIs caused by ESBL-EK also have prolonged hospital stays and higher antibiotic costs. Early detection of ESBLs and appropriate antibiotic coverage are likely to shorten hospital stays and reduce medical costs.
背景/目的：由大肠杆菌和肺炎克雷伯菌引起的社区获得性菌血症性尿路感染（UTI）的数量正在增加。然而，产超广谱β-内酰胺酶（ESBL）的大肠杆菌和肺炎克雷伯菌（ESBL-EK）对菌血症性 UTI 结局的影响尚不清楚。本研究旨在回顾性分析 ESBL-EK 对社区获得性菌血症性 UTI 的影响。
在纳入的 58 名患者中，有 12 名患有 ESBL-EK 引起的社区获得性菌血症性 UTI。患者分为 ESBL（n=12）和非 ESBL（n=46）组。诊断基于入院时同时发生的伴同菌血症和由同一病原体引起的菌尿。
ESBL 组的男性患者明显更多（66.7%vs. 23.9%；p=0.005），留置导尿管（41.7%vs. 6.5%；p=0.002），来自其他医疗机构的住院患者（50.0%vs. 8.7%；p=0.001）和急性生理学和慢性健康评估 II 评分较高的患者（23.3±7.1 vs. 15.9±6.3；p=0.001）和入住重症监护病房的患者（41.7%vs. 4.4%；p=0.003）比非 ESBL 组更多。多因素逻辑回归分析显示，男性（优势比=9.2；95%置信区间=1.7-50.6）和医疗机构住院（优势比=15.5；95%置信区间=2.4-98.9）是菌血症性 UTI 中 ESBL 产生的独立危险因素。尽管两组的死亡率相似（8.3%vs. 4.4%；p=0.403），但 ESBL 组的住院时间更长（16.3±9.3 天 vs. 7.9±5.2 天；p=0.010）和抗生素费用更高（615.1±423.5 美元 vs. 252.8±269.2 美元，p=0.014）。
男性和医疗机构住院是社区获得性菌血症性 UTI 患者中 ESBL 产生的危险因素。由 ESBL-EK 引起的菌血症性 UTI 患者的住院时间也更长，抗生素费用更高。早期检测 ESBLs 并进行适当的抗生素覆盖可能会缩短住院时间并降低医疗费用。
