Hospital del Mar, Barcelona, Spain.
Braz J Infect Dis. 2011 Jul-Aug;15(4):370-6. doi: 10.1590/s1413-86702011000400012.
The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective case-control study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48 h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002).
Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.
本研究旨在确定产超广谱β-内酰胺酶（ESBL）的大肠埃希菌和肺炎克雷伯菌菌血症的危险因素。
这是在西班牙巴塞罗那一家 450 床位的急性护理学术性三级医院进行的回顾性病例对照研究。病例包括 53 例产 ESBL 的大肠埃希菌或肺炎克雷伯菌菌血症患者，以及 159 例非产 ESBL 的大肠埃希菌或肺炎克雷伯菌菌血症对照患者。对照患者与病例患者按照感染菌种类、年龄和发病前 24-48 小时内通过简化急性生理学评分（SAPS II）系统计算的疾病严重程度进行 3:1 匹配。与对照组相比，病例组更常接受抗菌药物治疗（56.5%比 17%，p < 0.001）。二元逻辑回归显示，血流感染前 90 天内接受的不同抗菌药物种类数（> 2 种）是血液培养中产 ESBL 的大肠埃希菌或肺炎克雷伯菌的唯一预测因子（OR = 2.29，95%CI 1.35-3.88，p = 0.002）。
血流感染患者之前使用不同类别的抗菌药物（> 2 种）会增加产 ESBL 菌株的风险。
