UMR 6249 chrono-environnement, service d'hygiène hospitalière, centre d'investigation clinique BT506, CHRU de Besançon, université de Franche-Comté, 3, boulevard Fleming, 25030 Besançon cedex, France.
Med Mal Infect. 2013 Aug;43(8):331-6. doi: 10.1016/j.medmal.2013.06.001. Epub 2013 Jul 19.
We had for objective to measure the incidence and the clonal diversity of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBL) in order to assess the role of patient stay in amplification of the phenomenon, in our teaching hospital.
We measured the quarterly incidence rates of E. coli and K. pneumoniae producing or not producing ESBL in clinical samples between 1999 and 2010. The incidence of ESBL-producing isolates was season-adjusted. We determined the pulsotype of and identified the ESBL in all non-redundant strains isolated between 2009 and 2010.
The incidence for 1000 hospitalization days increased from 0.00 to 0.44 for ESBL-producing E. coli, from 0.012 to 0.24 for ESBL-producing K. pneumoniae, from 1999 to 2010. Fifty-three different clones of E. coli were identified among the 61 genotyped isolates. The 28 K. pneumoniae isolates genotyped clustered into 11 different clones, among which one major epidemic clone that included 18 isolates. Respectively 66 and 75% of E. coli and K. pneumoniae isolates produced a CTX-M group 1 ESBL.
The hospital seems to play a different role in the amplification of ESBL according to the producing species (K. pneumoniae or E. coli). ESBL-producing E. coli seem to have a limited cross-transmission within the hospital and seem to be added to non-producers. Conversely, ESBL-producing K. pneumoniae seem to be cross-transmitted within the hospital and to replace non-producers.
我们的目的是测量产超广谱β-内酰胺酶（ESBL）的大肠杆菌和肺炎克雷伯菌的发生率和克隆多样性，以评估患者在我院住院时间对该现象的放大作用。
我们测量了 1999 年至 2010 年期间临床标本中产生或不产生 ESBL 的大肠杆菌和肺炎克雷伯菌的季度发生率。对 ESBL 产生分离株的发生率进行了季节性调整。我们确定了 2009 年至 2010 年期间所有非冗余分离株的脉冲类型并鉴定了 ESBL。
每 1000 个住院日的发生率，产 ESBL 的大肠杆菌从 0.00 增加到 0.44，产 ESBL 的肺炎克雷伯菌从 0.012 增加到 0.24，从 1999 年到 2010 年。在 61 个基因分型分离株中鉴定出 53 个不同的大肠杆菌克隆。11 个不同克隆的 28 个肺炎克雷伯菌分离株聚类，其中包括 18 个分离株的主要流行克隆。分别有 66%和 75%的大肠杆菌和肺炎克雷伯菌分离株产生 CTX-M 组 1 ESBL。
医院根据产生的物种（肺炎克雷伯菌或大肠杆菌）似乎在 ESBL 的放大中发挥不同的作用。产 ESBL 的大肠杆菌在医院内的传播似乎受到限制，并且似乎会添加到非生产者中。相反，产 ESBL 的肺炎克雷伯菌在医院内似乎会交叉传播，并取代非生产者。
