Laboratory of Infectious Diseases, University of Crete, Crete, Greece.
J Antimicrob Chemother. 2011 Jun;66(6):1383-91. doi: 10.1093/jac/dkr116. Epub 2011 Mar 31.
To identify the roles of various antibiotics as risk factors for carbapenem-resistant extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (KP) infection (ESBL-KP infection).
Data were collected over 26 months in a tertiary care university hospital with established endemicity of carbapenem-resistant ESBL-KP (ESBL-CRKP). Using a case-case-control design, patients who presented an infection caused by carbapenem-susceptible ESBL-KP (ESBL-CSKP) and patients with ESBL-CRKP infection were compared with a common control group of hospitalized patients. Effects of treatment and duration of treatment with antibiotics were examined, adjusting for major non-antibiotic risk factors and controlling for confounding effects among the antibiotics via logistic regression models.
Ninety-six ESBL-CRKP cases, 55 ESBL-CSKP cases and 151 controls were analysed. Multivariate analysis, adjusting for major non-antibiotic risk factors, showed that the risk of ESBL-CRKP infection rose with increasing duration of prior treatment with β-lactam/β-lactamase inhibitor combinations [odds ratio (OR) 1.15 per day increase; P = 0.001] and revealed that increased duration of treatment with fluoroquinolones amplified the impact of exposure to carbapenems (and vice versa) on ESBL-CRKP infection risk (OR 1.02 for interaction term; P = 0.009). Duration of prior treatment with fluoroquinolones was also associated with increased risk of ESBL-CSKP infection (OR 1.07 per day increase; P = 0.028), while prior receipt of carbapenems presented a protective effect against ESBL-CSKP infection (OR 0.21; P = 0.003).
This study highlights the major role of treatment and duration of treatment with β-lactam/β-lactamase inhibitor combinations and combinations of carbapenems with fluoroquinolones. Clinicians should counterweight the potential benefits of administering these antibiotics against the increased risk of ESBL-CRKP infection.
确定各种抗生素在产碳青霉烯类超广谱β-内酰胺酶（ESBL）肺炎克雷伯菌（KP）感染（ESBL-KP 感染）的危险因素中的作用。
在一家三级保健大学医院进行了为期 26 个月的数据收集，该医院存在碳青霉烯类耐药性 ESBL-KP（ESBL-CRKP）的地方性流行。使用病例对照研究设计，比较了患有碳青霉烯类敏感 ESBL-KP（ESBL-CSKP）感染的患者和 ESBL-CRKP 感染的患者与住院患者的一般对照组。通过逻辑回归模型，检查了抗生素治疗和治疗持续时间的影响，并调整了主要非抗生素危险因素，同时控制了抗生素之间的混杂效应。
分析了 96 例 ESBL-CRKP 病例、55 例 ESBL-CSKP 病例和 151 例对照。多变量分析调整了主要非抗生素危险因素，表明先前接受β-内酰胺/β-内酰胺酶抑制剂联合治疗的时间长短与 ESBL-CRKP 感染风险增加有关[每天增加的优势比（OR）为 1.15；P=0.001]，并且表明氟喹诺酮类药物治疗时间的延长放大了碳青霉烯类药物暴露对 ESBL-CRKP 感染风险的影响（交互项的 OR 为 1.02；P=0.009）。先前接受氟喹诺酮类药物治疗的时间也与 ESBL-CSKP 感染的风险增加有关（每天增加的 OR 为 1.07；P=0.028），而先前接受碳青霉烯类药物治疗则对 ESBL-CSKP 感染具有保护作用（OR 为 0.21；P=0.003）。
本研究强调了β-内酰胺/β-内酰胺酶抑制剂联合和碳青霉烯类药物与氟喹诺酮类药物联合治疗以及治疗时间的重要作用。临床医生在权衡使用这些抗生素的潜在益处与 ESBL-CRKP 感染风险增加之间应权衡利弊。
