血流感染中产超广谱β-内酰胺酶（ESBL）肺炎克雷伯菌的分子流行病学及死亡危险因素
Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality.
作者信息
Gürntke Stephan, Kohler Christian, Steinmetz Ivo, Pfeifer Yvonne, Eller Christoph, Gastmeier Petra, Schwab Frank, Leistner Rasmus
机构信息
Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
Friedrich Löffler Institute of Medical Microbiology, Universitätsmedizin Greifswald, Martin-Luther-Str.6, 17475 Greifswald, Germany.
出版信息
J Infect Chemother. 2014 Dec;20(12):817-9. doi: 10.1016/j.jiac.2014.08.012. Epub 2014 Sep 13.
The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.
产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌在全球范围内的流行率正在上升。这些细菌感染被怀疑与死亡率增加有关。我们旨在估计ESBL基因型的分布，并评估肺炎克雷伯菌引起的血流感染（BSI）病例中ESBL阳性与死亡率的相关性。我们对2008年至2011年期间患有肺炎克雷伯菌BSI的患者进行了一项队列研究。通过PCR和测序分析ESBL基因的存在情况。通过Cox比例风险回归分析死亡率的危险因素。我们确定了286例ESBL阴性（81%）和66例（19%）ESBL阳性病例。97%（n = 64）的ESBL阳性分离株对美罗培南敏感。最常见的ESBL基因型是CTX-M-15（60%）、SHV-5（27%）和CTX-M-3（5%）。死亡率的显著危险因素是慢性肺病（HR 1.747）和中度/重度肾病（HR 2.572）。ESBL阳性与死亡率增加无关。
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