Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea.
Dig Dis Sci. 2013 Mar;58(3):841-9. doi: 10.1007/s10620-012-2398-7. Epub 2012 Sep 14.
Clinical outcomes associated with Gram-negative bacterial isolates with extended spectrum beta-lactamase (ESBL) in patients with biliary tract infection are largely unknown. The objective of the present study was to compare the demographics, risk factors, and clinical outcomes between patients with biliary tract infection caused by ESBL-producing and non-producing Klebsiella pneumoniae and Escherichia coli.
Between February 2005 and August 2010, we collected 159 cases with biliary tract infection caused by K. pneumoniae and E. coli identified by blood or bile cultures obtained before endoscopic or surgical treatment performed at our institution. We also retrospectively collected the data of patients' demographic characteristics, co-morbid conditions, antimicrobial therapy, and clinical outcomes.
Among the 159 strains isolated, 21 strains (13.2 %) were positive for phenotypical ESBL-test. Sepsis was more common in ESBL-positive strains, but did not reach statistical significance (23.8 % for ESBL-positive strains and 9.4 % for ESBL-negative strains, P = 0.066). Thirty-day mortality was significantly higher in ESBL-positive strains (3/21, 14.3 %) compared to ESBL-negative strains (4/138, 2.9 %, P = 0.049). However, there were no significant differences in overall survival between ESBL-positive and ESBL-negative strains. By multivariate analysis, inadequate antimicrobial therapy (HR 4.06, 95 % CI 1.08-16.46, P = 0.049) and sepsis (HR 6.54, 95 % CI 1.26-33.85, P = 0.025) were independent and significant predictors of 30-day mortality.
ESBL status of bacterial isolates for patients with biliary tract infection caused by K. pneumoniae and E. coli has clinical impact, especially on the short-term outcomes of those patients.
产超广谱β-内酰胺酶（ESBL）的革兰氏阴性细菌分离株与胆道感染患者的临床结局之间的关联在很大程度上尚未可知。本研究的目的是比较由产 ESBL 和非产 ESBL 的肺炎克雷伯菌和大肠埃希菌引起的胆道感染患者的人口统计学、危险因素和临床结局。
在 2005 年 2 月至 2010 年 8 月期间，我们收集了在我院进行内镜或手术治疗前从血液或胆汁培养物中分离出的 159 例由肺炎克雷伯菌和大肠埃希菌引起的胆道感染患者的资料。我们还回顾性地收集了患者的人口统计学特征、合并症、抗菌治疗和临床结局的数据。
在分离出的 159 株菌中，21 株（13.2%）对表型 ESBL 试验呈阳性。产 ESBL 阳性菌株更常见败血症，但未达到统计学意义（产 ESBL 阳性菌株为 23.8%，产 ESBL 阴性菌株为 9.4%，P=0.066）。30 天死亡率在产 ESBL 阳性菌株中明显更高（3/21，14.3%），而在产 ESBL 阴性菌株中则为 4/138（2.9%，P=0.049）。然而，产 ESBL 阳性和产 ESBL 阴性菌株之间的总生存率没有显著差异。多变量分析表明，抗菌治疗不充分（HR 4.06，95%CI 1.08-16.46，P=0.049）和败血症（HR 6.54，95%CI 1.26-33.85，P=0.025）是 30 天死亡率的独立和显著预测因素。
产 ESBL 的肺炎克雷伯菌和大肠埃希菌分离株对胆道感染患者具有临床影响，特别是对这些患者的短期结局有影响。
