Nguyen My-Linh, Toye Baldwin, Kanji Salmaan, Zvonar Rosemary
BScPhm, ACPR, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario.
MD, FRCPC, is with the Divisions of Microbiology and Infectious Diseases, The Ottawa Hospital, and the Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
Can J Hosp Pharm. 2015 Mar-Apr;68(2):136-43. doi: 10.4212/cjhp.v68i2.1439.
Antimicrobial resistance due to production of extended-spectrum ß-lactamases by Escherichia coli and Klebsiella species (ESBL-EK) is concerning. Previous studies have shown that bacteremia due to ESBL-producing organisms is associated with increases in length of stay and/or mortality rate. Rates of infection by ESBL-EK vary worldwide, and regional differences in the prevalence of risk factors are likely. Few Canadian studies assessing risk factors for ESBL-EK infections or the outcomes of empiric therapy have been published.
To determine risk factors for and patient outcomes associated with ESBL-EK bacteremia. The appropriateness of empiric antibiotic therapy and the effect of inappropriate empiric therapy on these outcomes were also examined.
In a retrospective, 1:1 case-control study conducted in a tertiary care hospital between 2005 and 2010, data for 40 patients with ESBL-EK bacteremia were compared with data for 40 patients who had non-ESBL-EK bacteremia.
Of all variables tested, only antibiotic use within the previous 3 months was found to be an independent risk factor for acquisition of ESBL-EK bacteremia (odds ratio 5.2, 95% confidence interval 1.6-16.9). A greater proportion of patients with non-ESBL-EK bacteremia received appropriate empiric therapy (88% [35/40] versus 15% [6/40], p < 0.001). Time to appropriate therapy was longer for those with ESBL-EK bacteremia (2.42 days versus 0.17 day, p < 0.001). Patient outcomes, including length of stay in hospital, admission to the intensive care unit (ICU), length of stay in the ICU (if applicable), and in-hospital mortality were not affected by the presence of ESBL-EK or the appropriateness of empiric therapy.
Previous antibiotic use was a significant, independent risk factor for acquiring ESBL-EK. Thus, prior antibiotic use is an important consideration in the selection of empiric antibiotic therapy and should increase the concern for resistant pathogens.
大肠埃希菌和克雷伯菌属产生超广谱β-内酰胺酶（ESBL-EK）导致的抗菌药物耐药问题令人担忧。既往研究表明，产ESBL-EK的生物体所致菌血症与住院时间延长和/或死亡率增加相关。ESBL-EK的感染率在全球范围内各不相同，且风险因素的患病率可能存在地区差异。加拿大很少有研究评估ESBL-EK感染的风险因素或经验性治疗的结果。
确定ESBL-EK菌血症的风险因素及患者结局。同时还研究了经验性抗生素治疗的合理性以及不恰当的经验性治疗对这些结局的影响。
在2005年至2010年于一家三级护理医院进行的一项回顾性1:1病例对照研究中，将40例ESBL-EK菌血症患者的数据与40例非ESBL-EK菌血症患者的数据进行比较。
在所有测试变量中，仅发现前3个月内使用抗生素是获得ESBL-EK菌血症的独立风险因素（比值比5.2，95%置信区间1.6 - 16.9）。非ESBL-EK菌血症患者中接受恰当经验性治疗的比例更高（88% [35/40]对15% [6/40]，p < 0.001）。ESBL-EK菌血症患者达到恰当治疗的时间更长（2.42天对0.17天，p < 0.001）。患者结局，包括住院时间、入住重症监护病房（ICU）、在ICU的住院时间（如适用）以及院内死亡率，不受ESBL-EK的存在或经验性治疗合理性的影响。
既往使用抗生素是获得ESBL-EK的一个重要独立风险因素。因此，在选择经验性抗生素治疗时，既往抗生素使用是一个重要的考虑因素，并且应增加对耐药病原体的关注。
