Biehl Lena M, Schmidt-Hieber Martin, Liss Blasius, Cornely Oliver A, Vehreschild Maria J G T
a 1st Department of Internal Medicine , University of Cologne , Cologne , Germany .
b Klinik für Hämatologie, Onkologie und Tumorimmunologie , HELIOS Klinikum Berlin Buch , Berlin , Germany .
Crit Rev Microbiol. 2016;42(1):1-16. doi: 10.3109/1040841X.2013.875515. Epub 2014 Feb 4.
The prevalence of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) is increasing worldwide. ESBL-E are known to colonize different body sites and cause bloodstream infections (BSI), pneumonia, intra-abdominal infections and urinary tract infections. Even though ESBL-E-related morbidity and mortality in high-risk patients - patients receiving immunosuppressants or chemotherapy, as well as those treated in an ICU - is considerable, the management of ESBL-E in these populations has not been systematically reviewed.
For the purpose of this review, ICU patients, patients in hematology and oncology wards and transplant recipients were considered high-risk. An English-language Medline search was conducted to identify literature on epidemiology, risk factors, clinical impact and measures of infection control regarding ESBL-E in high-risk patients published between June 2002 and May 2013.
Using the above described methodology, 43 relevant articles regarding high-risk patients and - for areas where literature on exclusively high-risk patients is scarce - 17 articles in standard risk settings were identified. The evidence on epidemiology, associated risk factors, treatment and hygiene measures were summarized.
This review gives a complete overview on the management of ESBL-E in the high-risk setting.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）在全球的流行率正在上升。已知ESBL-E可定植于不同身体部位，并引起血流感染（BSI）、肺炎、腹腔内感染和尿路感染。尽管在高危患者（接受免疫抑制剂或化疗的患者以及在重症监护病房接受治疗的患者）中，与ESBL-E相关的发病率和死亡率相当高，但尚未对这些人群中ESBL-E的管理进行系统综述。
为进行本综述，将重症监护病房患者、血液科和肿瘤科病房患者以及移植受者视为高危人群。进行了英文的医学文献数据库检索，以识别2002年6月至2013年5月期间发表的关于高危患者中ESBL-E的流行病学、危险因素、临床影响和感染控制措施的文献。
使用上述方法，确定了43篇关于高危患者的相关文章，以及在标准风险环境下的17篇文章（在专门针对高危患者的文献稀缺的领域）。总结了关于流行病学、相关危险因素、治疗和卫生措施的证据。
本综述全面概述了高危环境中ESBL-E的管理。
