产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌所致尿路感染的临床和实验室特征

Clinical and Laboratory Profile of Urinary Tract Infections Associated with Extended Spectrum β-Lactamase Producing Escherichia coli and Klebsiella pneumoniae.

作者信息

Al Yousef Sulaiman Ali, Younis Sabry, Farrag Eman, Moussa Husseiny Sh, Bayoumi Faten Sayed, Ali Ahmed Mohamed

机构信息

Department of Medical Laboratory Technology, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin, Kingdom of Saudi Arabia.

Faculty of Women for Art, Science and Education, Ain Shams University, Cairo, Egypt.

出版信息

Ann Clin Lab Sci. 2016 Jul;46(4):393-400.

PMID:27466299

Abstract

BACKGROUND

Urinary tract infection (UTI) is mainly due to invasion of the urethra, bladder or kidneys by pathogens. The emergence of extended spectrum β-lactamases (ESBL) is responsible for frequently observed empirical therapy failures.

OBJECTIVES

To study the clinical and laboratory characteristics of UTIs caused by ESBL producing Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumonia).

METHODS

A cross-sectional clinical and laboratory study was performed at King Khalid Hospital, Hafr Al Batin, Saudi Arabia between March 2014 to October 2015. A total of 908 urine samples from suspected UTI patients was collected. Samples were isolated on Cysteine Electrolyte-Deficient (CLED) agar. Positive cultures were identified and tested for antimicrobial susceptibility by MicroScan(®) WalkAway-96 SI System, and then ESBL was confirmed by double disc synergy test (DDST) and phenotypic confirmatory disc diffusion test (PCDDT).

RESULTS

A total of 680 samples (288 males and 392 females) were culture positive. 520 samples (76.5%) of E. Coli were found and 160 samples of K. pneumonia were identified (23.5%). ESBL testing showed 296 (218 E. coli and 78 K. pneumonia) samples of positive isolates. Non-ESBL isolates showed highest resistance to ampicillin followed by Mezocillin and Trimethoprim-Sulphamethoxazole-which are usually recommended as the initial treatment of UTI-while ESBL isolates showed resistance to third generation cephalosporin along with Ampicillin and Trimethoprim-Sulphamethoxazole. In this study, four significant risk factors for ESBL infection such as diabetes, recurrent UTI, previous use of antibiotics and previous hospitalization were found.

CONCLUSION

Identifying the risk factors and antibiotic susceptibility patterns associated with ESBL producing E. coli and K. pneumonia is a useful guide for treatment strategy and control of ESBL UTI.

摘要

背景

尿路感染（UTI）主要是由于病原体侵入尿道、膀胱或肾脏所致。超广谱β-内酰胺酶（ESBL）的出现是导致经验性治疗失败常见的原因。

目的

研究产ESBL的大肠埃希菌（大肠杆菌）和肺炎克雷伯菌（肺炎克雷伯菌）引起的尿路感染的临床和实验室特征。

方法

2014年3月至2015年10月在沙特阿拉伯哈费尔巴廷的哈立德国王医院进行了一项横断面临床和实验室研究。共收集了908份疑似UTI患者的尿液样本。样本在半胱氨酸缺电解质（CLED）琼脂上分离。通过MicroScan® WalkAway-96 SI系统对阳性培养物进行鉴定和药敏试验，然后通过双纸片协同试验（DDST）和表型确证纸片扩散试验（PCDDT）确认ESBL。

结果

共有680份样本（288例男性和392例女性）培养呈阳性。发现520份（76.5%）大肠杆菌样本和160份肺炎克雷伯菌样本（23.5%）。ESBL检测显示296份（218份大肠杆菌和78份肺炎克雷伯菌）阳性分离株样本。非ESBL分离株对氨苄西林耐药性最高，其次是美洛西林和甲氧苄啶-磺胺甲恶唑（通常推荐作为UTI的初始治疗药物），而ESBL分离株对第三代头孢菌素以及氨苄西林和甲氧苄啶-磺胺甲恶唑均耐药。在本研究中，发现了ESBL感染的四个重要危险因素，如糖尿病、复发性UTI、既往使用抗生素和既往住院史。