Sakellariou Christian, Gürntke Stephan, Steinmetz Ivo, Kohler Christian, Pfeifer Yvonne, Gastmeier Petra, Schwab Frank, Kola Axel, Deja Maria, Leistner Rasmus
Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany.
PLoS One. 2016 Jul 21;11(7):e0158039. doi: 10.1371/journal.pone.0158039. eCollection 2016.
Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are associated with increased mortality. Outcome differences due to various species of ESBL-E or ESBL genotypes are not well investigated. We conducted a cohort study to assess risk factors for mortality in cases of ESBL-E bacteremia (K. pneumoniae or E. coli) and the risk factors for sepsis with organ failure. All consecutive patients of our institution from 2008 to 2011 with bacteremia due to ESBL-E were included. Basic epidemiological data, underlying comorbidities, origin of bacteremia, severity of sepsis and delay of appropriate anti-infective treatment were collected. Isolates were PCR-screened for the presence of ESBL genes and plasmid-mediated AmpC β-lactamases. Cox proportional hazard regression on mortality and multivariable logistic regression on risk factors for sepsis with organ failure was conducted. 219 cases were included in the analysis: 73.1% due to E. coli, 26.9% due to K. pneumoniae. There was no significant difference in hospital mortality (ESBL-E. coli, 23.8% vs. ESBL-K. pneumoniae 27.1%, p = 0.724). However, the risk of sepsis with organ failure was associated in cases of K. pneumoniae bacteremia (OR 4.5, p<0.001) and patients with liver disease (OR 3.4, p = 0.004) or renal disease (OR 6.8, p<0.001). We found significant differences in clinical presentation of ESBL-E bacteremia due to K. pneumoniae compared to E. coli. As K. pneumoniae cases showed a more serious clinical presentation as E. coli cases and were associated with different risk factors, treatment and prevention strategies should be adjusted accordingly.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）感染与死亡率增加相关。关于不同种类的ESBL-E或ESBL基因型导致的结局差异尚未得到充分研究。我们进行了一项队列研究，以评估ESBL-E菌血症（肺炎克雷伯菌或大肠杆菌）患者的死亡危险因素以及伴有器官衰竭的脓毒症的危险因素。纳入了2008年至2011年我院所有因ESBL-E导致菌血症的连续患者。收集了基本流行病学数据、基础合并症、菌血症来源、脓毒症严重程度以及适当抗感染治疗的延迟情况。对分离株进行PCR筛查，以检测ESBL基因和质粒介导的AmpCβ-内酰胺酶的存在。进行了关于死亡率的Cox比例风险回归分析以及关于伴有器官衰竭的脓毒症危险因素的多变量逻辑回归分析。分析纳入了219例病例：73.1%由大肠杆菌引起，26.9%由肺炎克雷伯菌引起。医院死亡率无显著差异（ESBL-E大肠杆菌，23.8%对ESBL-肺炎克雷伯菌27.1%，p = 0.724）。然而，肺炎克雷伯菌菌血症患者（比值比4.5，p<0.001）以及患有肝病（比值比3.4，p = 0.004）或肾病（比值比6.8，p<0.001）的患者发生伴有器官衰竭的脓毒症的风险较高。我们发现，与大肠杆菌导致的ESBL-E菌血症相比，肺炎克雷伯菌导致的ESBL-E菌血症在临床表现上存在显著差异。由于肺炎克雷伯菌病例的临床表现比大肠杆菌病例更为严重，且与不同的危险因素相关，因此应相应调整治疗和预防策略。
