Division of Infectious and Tropical Diseases, Hospital of Lodi, Lodi, Italy.
J Antimicrob Chemother. 2012 Dec;67(12):2982-7. doi: 10.1093/jac/dks300. Epub 2012 Aug 3.
To assess risk factors for acquiring extended-spectrum β-lactamase-producing Gram-negative bacteria (ESBL+ GN) causing urinary tract infections (UTIs) in long-term care facilities (LTCFs).
A prospective case-case-control study was carried out. In the first study, cases were defined as patients harbouring ESBL+ GN, while, in the second study, cases were defined as patients harbouring ESBL-negative (ESBL-) GN. Controls were selected by simple random sampling from patients without GN infection. ESBL determinants were characterized by hybridization, and confirmed by PCR and sequencing.
The study involved 297 LTCF patients (99 with ESBL+ GN UTI, 99 with ESBL- GN UTI and 99 without GN infection). ESBL+ GN UTIs were due to Escherichia coli (64%), Proteus mirabilis (25%) and Klebsiella pneumoniae (11%). The CTX-M-type enzymes were the most prevalent (73% of isolates), whereas TEM- and SHV-type ESBLs and AmpC-type enzymes were less prevalent (10%, 2% and 15% of isolates, respectively). Patients with ESBL+ GN UTI were more likely to have a permanent urinary catheter (OR 15, 95% CI 6.9-30.5) and to have received antimicrobial therapy in the previous 30 days (OR 4, 95% CI 1.2-10.9). After adjusting for type, dosage and duration of antibiotic, exposure to ≥7 days of quinolones and third-generation cephalosporins was associated with the highest risk of ESBL+ GN UTI development (OR 7, 95% CI 1.2-40). Independent risk factors for acquiring ESBL- GN UTIs were previous surgical procedures (OR 2, 95% CI 1.1-4) and the presence of a urinary catheter (OR 8, 95% CI 4-16). No specific antibiotics remained a significant risk for ESBL- GN UTI after adjusting for demographic and clinical risk factors.
Exposure to ≥7 days of quinolones and third-generation cephalosporins significantly increases the risk of ESBL+ GN UTI. Interventions aimed at improving compliance with antimicrobial stewardship principles should be further developed and implemented in LTCFs.
评估长期护理机构（LTCF）中导致尿路感染（UTI）的产超广谱β-内酰胺酶革兰氏阴性菌（ESBL+ GN）的危险因素。
进行了一项前瞻性病例对照研究。在第一项研究中，将携带 ESBL+ GN 的患者定义为病例，而在第二项研究中，将携带 ESBL- GN 的患者定义为病例。对照通过简单随机抽样从无 GN 感染的患者中选择。通过杂交鉴定 ESBL 决定簇，并通过 PCR 和测序进行确认。
该研究涉及 297 名 LTCF 患者（99 例 ESBL+ GN UTI、99 例 ESBL- GN UTI 和 99 例无 GN 感染）。ESBL+ GN UTI 由大肠杆菌（64%）、奇异变形杆菌（25%）和肺炎克雷伯菌（11%）引起。CTX-M 型酶最为常见（73%的分离株），而 TEM-和 SHV 型 ESBL 和 AmpC 型酶则较为少见（分别占 10%、2%和 15%的分离株）。携带 ESBL+ GN UTI 的患者更有可能留置永久性导尿管（OR 15，95%CI 6.9-30.5），并且在过去 30 天内接受过抗菌治疗（OR 4，95%CI 1.2-10.9）。在调整了抗生素的类型、剂量和疗程、暴露于≥7 天的喹诺酮类和第三代头孢菌素类药物与 ESBL+ GN UTI 发展的最高风险相关（OR 7，95%CI 1.2-40）。发生 ESBL- GN UTI 的独立危险因素为既往手术（OR 2，95%CI 1.1-4）和留置导尿管（OR 8，95%CI 4-16）。在调整了人口统计学和临床危险因素后，没有特定的抗生素仍然是 ESBL- GN UTI 的显著危险因素。
暴露于≥7 天的喹诺酮类和第三代头孢菌素类药物显著增加了 ESBL+ GN UTI 的风险。应进一步制定和实施旨在提高抗菌药物管理原则的依从性的干预措施。
