Dautzenberg M J D, Haverkate M R, Bonten M J M, Bootsma M C J
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
BMJ Open. 2016 Mar 17;6(3):e009971. doi: 10.1136/bmjopen-2015-009971.
Observational studies have suggested that Escherichia coli sequence type (ST) 131 and Klebsiella pneumoniae ST258 have hyperendemic properties. This would be obvious from continuously high incidence and/or prevalence of carriage or infection with these bacteria in specific patient populations. Hyperendemicity could result from increased transmissibility, longer duration of infectiousness, and/or higher pathogenic potential as compared with other lineages of the same species. The aim of our research is to quantitatively estimate these critical parameters for E. coli ST131 and K. pneumoniae ST258, in order to investigate whether E. coli ST131 and K. pneumoniae ST258 are truly hyperendemic clones.
A systematic literature search was performed to assess the evidence of transmissibility, duration of infectiousness, and pathogenicity for E. coli ST131 and K. pneumoniae ST258. Meta-regression was performed to quantify these characteristics.
The systematic literature search yielded 639 articles, of which 19 data sources provided information on transmissibility (E. coli ST131 n=9; K. pneumoniae ST258 n=10)), 2 on duration of infectiousness (E. coli ST131 n=2), and 324 on pathogenicity (E. coli ST131 n=285; K. pneumoniae ST258 n=39). Available data on duration of carriage and on transmissibility were insufficient for quantitative assessment. In multivariable meta-regression E. coli isolates causing infection were associated with ST131, compared to isolates only causing colonisation, suggesting that E. coli ST131 can be considered more pathogenic than non-ST131 isolates. Date of isolation, location and resistance mechanism also influenced the prevalence of ST131. E. coli ST131 was 3.2 (95% CI 2.0 to 5.0) times more pathogenic than non-ST131. For K. pneumoniae ST258 there were not enough data for meta-regression assessing the influence of colonisation versus infection on ST258 prevalence.
With the currently available data, it cannot be confirmed nor rejected, that E. coli ST131 or K. pneumoniae ST258 are hyperendemic clones.
观察性研究表明，大肠杆菌序列型（ST）131和肺炎克雷伯菌ST258具有高流行特性。在特定患者群体中，这些细菌的携带或感染发病率和/或患病率持续居高不下，这一点将显而易见。与同一物种的其他谱系相比，高流行可能是由于传播性增加、感染持续时间延长和/或致病潜力更高。我们研究的目的是定量估计大肠杆菌ST131和肺炎克雷伯菌ST258的这些关键参数，以调查大肠杆菌ST131和肺炎克雷伯菌ST258是否真的是高流行克隆株。
进行系统的文献检索，以评估大肠杆菌ST131和肺炎克雷伯菌ST258的传播性、感染持续时间和致病性的证据。进行Meta回归以量化这些特征。
系统文献检索产生了639篇文章，其中19个数据源提供了关于传播性的信息（大肠杆菌ST131，n = 9；肺炎克雷伯菌ST258，n = 10），2个提供了关于感染持续时间的信息（大肠杆菌ST131，n = 2），324个提供了关于致病性的信息（大肠杆菌ST131，n = 285；肺炎克雷伯菌ST258，n = 39）。关于携带持续时间和传播性的现有数据不足以进行定量评估。在多变量Meta回归中，与仅引起定植的分离株相比，引起感染的大肠杆菌分离株与ST131相关，这表明大肠杆菌ST131可被认为比非ST131分离株更具致病性。分离日期、地点和耐药机制也影响了ST131的流行率。大肠杆菌ST131的致病性是非ST131的3.2倍（95%CI 2.0至5.0）。对于肺炎克雷伯菌ST258，没有足够的数据进行Meta回归来评估定植与感染对ST258流行率的影响。
根据目前可用的数据，无法证实或否定大肠杆菌ST131或肺炎克雷伯菌ST258是高流行克隆株。
