Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Euro Surveill. 2013 May 23;18(21):20484.
Increasing trends for invasive infections with extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae have been described in many countries worldwide. However, data on the rates of ESC-R isolates in non-invasive infections and in the outpatient setting are scarce. We used a laboratory-based nationwide surveillance system to compare temporal trends of ESC-R rates in Escherichia coli and Klebsiella pneumoniae for in- and outpatients in Switzerland. Our data showed a significant increase in ESC-R rates from 1% to 5.8% in E. coli (p<0.001) and from 1.1% to 4.4% in K. pneumoniae (p=0.002) during an eight-year period (2004–2011). For E. coli, the increase was significantly higher in inpatients (from 1.2% to 6.6%), in patients residing in eastern Switzerland (from 1.0% to 6.2%), in patients older than 45 years (from 1.2% to 6.7%), and in male patients (from 1.2% to 8.1%). While the increase in inpatients was linear (p<0.001) for E. coli, the increase of ESC R K. pneumoniae isolates was the result of multiple outbreaks in several institutions. Notably, an increasing proportion of ESC-R E. coli was co-resistant to both trimethoprim-sulfamethoxazole and quinolones (42% in 2004 to 49.1% in 2011, p=0.009), further limiting the available oral therapeutic options.
在世界范围内，许多国家都描述了具有广谱头孢菌素耐药（ESC-R）的肠杆菌科侵袭性感染呈上升趋势。然而，关于非侵袭性感染和门诊环境中 ESC-R 分离株的发生率的数据却很少。我们使用基于实验室的全国性监测系统比较了瑞士住院和门诊患者中大肠埃希菌和肺炎克雷伯菌的 ESC-R 率的时间趋势。我们的数据显示，在 8 年期间（2004-2011 年），大肠埃希菌的 ESC-R 率从 1%增加到 5.8%（p<0.001），肺炎克雷伯菌的 ESC-R 率从 1.1%增加到 4.4%（p=0.002）。对于大肠埃希菌，住院患者（从 1.2%增加到 6.6%）、居住在瑞士东部的患者（从 1.0%增加到 6.2%）、年龄大于 45 岁的患者（从 1.2%增加到 6.7%）和男性患者（从 1.2%增加到 8.1%）的增加更为明显。尽管大肠埃希菌住院患者的增加呈线性趋势（p<0.001），但 ESC-R 肺炎克雷伯菌分离株的增加是多个机构爆发的结果。值得注意的是，ESC-R 大肠埃希菌的 co-耐药性（对甲氧苄啶-磺胺甲噁唑和喹诺酮类药物均耐药）的比例逐渐增加（2004 年为 42%，2011 年为 49.1%，p=0.009），进一步限制了可用的口服治疗选择。
