Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran.
Chemotherapy. 2011;57(2):134-7. doi: 10.1159/000323623. Epub 2011 Mar 31.
Cefepime is active against bacteria producing chromosomally and plasmid-mediated extended broad-spectrum β-lactamase enzymes. The aim of this study was to evaluate risk factors for acquisition of cefepime resistance in Escherichia coli strains among hospitalized patients in a university hospital in Sanandaj, Iran. The study was a case-control investigation. A case patient was defined as a patient who had one isolate of a cefepime-resistant E. coli strain. A control patient was defined as a patient who had one isolate of a cefepime-sensitive E. coli strain. Cefepime resistance was determined by HiComb MIC tests (HIMEDIA, India). Out of the 255 total isolates, 73 (28.6%) were resistant to cefepime. The previous treatment of cefepime was a risk factor for acquisition of a cefepime-resistant isolate (OR = 6.32, 95% CI: 1.5-25.19, p < 0.007). The use of a ventilator was considered to be a risk for acquisition of a cefepime-resistant isolate (OR = 6.25, 95% CI: 1.86-21.02, p <0.002). The use of a catheter was also found to be a risk factor for acquisition of cefepime resistance (OR = 6.28, 95% CI: 1.86-21.02, p <0.001). There was a significant correlation between days of stay in hospital wards and cefepime resistance (p < 0.003). The main risk factors associated with cefepime resistance were previous treatment with cefepime, use of ventilator, use of catheter and days of stay in ward. More studies are needed to evaluate the role of these factors in order to control the spread of drug resistance.
头孢吡肟对染色体和质粒介导的扩展广谱β-内酰胺酶的细菌具有活性。本研究旨在评估伊朗赞詹大学医院住院患者中大肠埃希菌获得头孢吡肟耐药的危险因素。该研究是一项病例对照研究。病例患者定义为分离出一株头孢吡肟耐药大肠埃希菌的患者。对照患者定义为分离出一株头孢吡肟敏感大肠埃希菌的患者。头孢吡肟耐药性通过 HiComb MIC 试验（印度 HIMEDIA）确定。在 255 个总分离株中，有 73 株（28.6%）对头孢吡肟耐药。之前使用头孢吡肟是获得头孢吡肟耐药分离株的危险因素（OR = 6.32，95%CI：1.5-25.19，p < 0.007）。使用呼吸机被认为是获得头孢吡肟耐药分离株的危险因素（OR = 6.25，95%CI：1.86-21.02，p < 0.002）。使用导管也被发现是获得头孢吡肟耐药的危险因素（OR = 6.28，95%CI：1.86-21.02，p < 0.001）。住院天数与头孢吡肟耐药之间存在显著相关性（p < 0.003）。与头孢吡肟耐药相关的主要危险因素是之前使用头孢吡肟、使用呼吸机、使用导管和住院天数。需要进一步研究这些因素在控制耐药性传播中的作用。
