Cho Sun Young, Kang Cheol-In, Cha Min Kyeong, Wi Yu Mi, Ha Young Eun, Chung Doo Ryeon, Lee Nam Yong, Peck Kyong Ran, Song Jae-Hoon
1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea.
2 Asia Pacific Foundation for Infectious Diseases (APFID) , Seoul, Korea.
Microb Drug Resist. 2015 Aug;21(4):463-9. doi: 10.1089/mdr.2014.0261. Epub 2015 Mar 10.
Despite the remarkable emergence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli sequence type 131 (ST131), the clinical features and outcomes of infections caused by ST131 remain poorly described. From 2011 to 2012, we collected ESBL-producing E. coli isolates from patients with bloodstream infections in 13 hospitals in Korea and compared clinical characteristics and outcomes between ST131 and non-ST131 clones. Of the 110 ESBL-producing isolates, the most common ST was ST131 (30.9%). Multivariate analysis showed that recent operation was the only variable associated with the ST131 clone; other comorbid conditions and clinical features were similar between ST131 and non-ST131 clones. CTX-M-14 and CTX-M-15 were the predominant types of ESBLs, and CTX-M-15 was significantly associated with ST131. The rate of nonsusceptibility to ciprofloxacin was higher in ST131 than in non-ST131 clones (94.1% vs. 75.0%). No significant differences in 30-day mortality rates were found between ST131 and non-ST131 clones. Multivariate analysis revealed that older age (odds ratio [OR]=5.39, 95% confidence interval [CI] 1.22-23.89; p=0.027), nosocomial infection (OR=4.81, 95% CI 1.15-20.15; p=0.032), and higher Pitt bacteremia score (OR=7.26, 95% CI 1.41-37.42; p=0.018) were independent risk factors for 30-day mortality. The ESBL-producing E. coli ST131 clone has emerged and disseminated in Korea. Our findings reveal similarities in clinical and demographic characteristics between ST131 and non-ST131 clones. Although a more resistant profile has been detected in ST131, patients with the ST131 clone did not exhibit a higher mortality rate.
尽管产超广谱β-内酰胺酶（ESBL）的大肠杆菌序列类型131（ST131）显著出现，但由ST131引起的感染的临床特征和转归仍描述甚少。2011年至2012年，我们从韩国13家医院的血流感染患者中收集了产ESBL的大肠杆菌分离株，并比较了ST131和非ST131克隆株之间的临床特征和转归。在110株产ESBL的分离株中，最常见的序列类型是ST131（30.9%）。多变量分析显示，近期手术是与ST131克隆株相关的唯一变量；ST131和非ST131克隆株之间的其他合并症和临床特征相似。CTX-M-14和CTX-M-15是ESBL的主要类型，且CTX-M-15与ST131显著相关。ST131对环丙沙星的不敏感率高于非ST131克隆株（94.1%对75.0%）。ST131和非ST131克隆株之间在30天死亡率方面未发现显著差异。多变量分析显示，年龄较大（比值比[OR]=5.39，95%置信区间[CI] 1.22 - 23.89；p=0.027）﹑医院感染（OR=4.81，95% CI 1.15 - 20.15；p=0.032）和较高的皮特菌血症评分（OR=7.26，95% CI 1.41 - 37.42；p=0.018）是30天死亡率的独立危险因素。产ESBL的大肠杆菌ST131克隆株已在韩国出现并传播。我们的研究结果揭示了ST131和非ST131克隆株在临床和人口统计学特征方面的相似性。尽管在ST131中检测到了更高的耐药性，但携带ST131克隆株的患者并未表现出更高的死亡率。
