Dias Andrea, Oliveira Guiomar, Oliveira Henrique, Marques Margarida, Rodrigues Fernanda
Unidadede Infecciologia, Hospital Pediátrico de Coimbra, Coimbra, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:197-206. Epub 2011 Dec 31.
Enterobacteriaceae are a common cause of invasive disease in children. The production of extended-spectrum ß-lactamase (ESBL) by these bacteria and consequent resistance to several antibiotics has increased. The paediatric data are scarce.
To identify children infected with ESBL-producing bacilli, determining their prevalence in health care related infection and community-acquired disease. To analyse demographic, clinical, laboratory, therapeutic and follow-up data. To identify potential risk factors for infection by ESBL-producing organisms.
A case-control study, conducted in a level III paediatric hospital, from July 2007 to December 2009. All patients were identified from the microbiology database. Children infected by ESBL-producing bacilli were compared with a group with infection by non-ESBL producers, selected in a systematic way, given the bacteria, product and date of isolation. Statistical data analysis was performed using SPSS® 17.1.
The ESBL-producing phenotype was detected in 0.5% of Escherichia coli and 16.4% of Klebsiella spp identified. These bacteria were isolated in 23 children: 7 Escherichia coli (30.4%), 15 Klebsiella pneumoniae (65.2%) and 1 Klebsiella oxytoca (4.3%). The most common diagnosis was urinary tract infection (39%). Hospital admission was required in 70% of the cases versus 50% controls (p=0.141), with mean duration stay of 69 days for cases and 36 days for controls (p=0.235). The mean time between admission and infection was 32 days in both (p=0.978). Health care related infections were identified in 70% of cases versus 25% of controls (p=0.001). Infections due to ESBL producing organisms occurred in the community setting particularly in the last year of the study (n=4). The presence of chronic disease (p=0.022) and previous hospitalization (p=0.025), antibiotic use (p=0.008) and invasive ventilation (p=0.002) were more common in infection caused by ESBL-producing bacteria. Surgery (p=0.175) and the presence of a central venous catheter (p=0.189) were not risk factors. In a multivariate analysis, only prior invasive ventilation was an independent risk factor for infection by ESBL-producing bacteria (p=0.002, OR=7).
The ESBL-producing phenotype was detected in 0.5% Escherichia coli and 16.4% Klebsiella spp identified; mainly in health care related infections. The presence of chronic disease and previous hospitalization, invasive ventilation and antibiotic intake were more common in infections caused by these bacteria. Prior invasive ventilation was an independent risk factor.
肠杆菌科细菌是儿童侵袭性疾病的常见病因。这些细菌产生超广谱β-内酰胺酶（ESBL）并因此对多种抗生素产生耐药性的情况有所增加。儿科方面的数据较少。
识别感染产ESBL杆菌的儿童，确定其在医疗相关感染和社区获得性疾病中的患病率。分析人口统计学、临床、实验室、治疗及随访数据。识别产ESBL生物感染的潜在危险因素。
2007年7月至2009年12月在一家三级儿科医院进行了一项病例对照研究。所有患者均从微生物学数据库中识别。将感染产ESBL杆菌的儿童与一组非产ESBL菌感染者进行比较，根据细菌、产物及分离日期进行系统选择。使用SPSS® 17.1进行统计数据分析。
在鉴定出的大肠杆菌中，产ESBL表型在0.5%中被检测到，在克雷伯菌属中为16.4%。这些细菌在23名儿童中分离得到：7例大肠杆菌（30.4%），15例肺炎克雷伯菌（65.2%）和1例产酸克雷伯菌（4.3%）。最常见的诊断是尿路感染（39%）。70%的病例需要住院，而对照组为50%（p = 0.141），病例组平均住院时间为69天，对照组为36天（p = 0.235）。两组患者入院至感染的平均时间均为32天（p = 0.978）。70%的病例为医疗相关感染，而对照组为25%（p = 0.001）。产ESBL生物引起的感染发生在社区环境中，尤其是在研究的最后一年（n = 4）。慢性病（p = 0.022）、既往住院史（p = 0.025）、抗生素使用（p = 0.008）和有创通气（p = 0.002）在产ESBL细菌引起的感染中更为常见。手术（p = 0.175）和中心静脉导管的存在（p = 0.189）不是危险因素。在多变量分析中，只有既往有创通气是产ESBL细菌感染的独立危险因素（p = 0.002，比值比=7）。
在鉴定出的大肠杆菌中，0.5%检测到产ESBL表型，在克雷伯菌属中为16.4%；主要发生在医疗相关感染中。慢性病、既往住院史、有创通气和抗生素摄入在这些细菌引起的感染中更为常见。既往有创通气是独立危险因素。
