Calitri Carmelina, Scolfaro Carlo, Colombo Sara, De Intinis Gianfranco, Carraro Francesca, Garazzino Silvia, Tovo Pier-Angelo
Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
Microbiology Laboratory, Regina Margherita Children's Hospital and Sant'Anna Hospital, A.O.U. Cittá della Salute e della Scienza di Torino, Turin, Italy.
Infez Med. 2016 Dec 1;24(4):318-325.
A prospective 18-month case-control study was performed in a tertiary Paediatric Centre in Turin (Italy) to analyse the disease burden and identify risk factors for acquisition of Extended Spectrum Beta Lactamase-producing Enterobacteriaceae (ESBL-pE). Children with ESBL-pE isolation were enrolled as cases, with controls matched according to age, type of pathogen isolated and sample of isolation. Out of 83 children (37 males, mean age 4.7 ± 5.46 years), 45 were identified as infected (54.2%) and 38 as colonised (45.8%) by ESBL-pE. Twenty-nine (64.4%) infectious disease episodes were categorised as community-acquired, 16 (35.6%) as healthcare-associated. Escherichia coli was the most frequently isolated pathogen (52, 62.7%) and the urinary tract the most frequent site involved (26, 57.9%). No deaths occurred, even in bloodstream infection cases. Hospitalisation and exposure to broad-spectrum penicillins and III/IV generation cephalosporins in the 90-day period before bacteria isolation were found to be independent risk factors at multivariate analysis. Immunodepression, prolonged central venous catheter (CVC) and urine catheter stay, and receiving a total parenteral nutrition (TPN) in the previous 30 days were otherwise recognized as potential risk factors at univariated analysis. ESBL-producing Enterobacteriaceae infections are a growing threat even in children. Careful recognition of patients at risk should promote targeted interventions in order to reduce the ESBL burden.
在意大利都灵的一家三级儿科中心进行了一项为期18个月的前瞻性病例对照研究，以分析疾病负担并确定获得产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-pE）的危险因素。将分离出ESBL-pE的儿童纳入病例组，对照组根据年龄、分离出的病原体类型和分离样本进行匹配。在83名儿童（37名男性，平均年龄4.7±5.46岁）中，45名被确定为ESBL-pE感染（54.2%），38名被确定为定植（45.8%）。29例（64.4%）感染性疾病发作被归类为社区获得性，16例（35.6%）为医疗保健相关。大肠埃希菌是最常分离出的病原体（52株，62.7%），泌尿道是最常受累的部位（26例，57.9%）。即使在血流感染病例中也没有死亡发生。在多变量分析中，发现细菌分离前90天内住院以及接触广谱青霉素和第三代/第四代头孢菌素是独立的危险因素。在单变量分析中，免疫抑制、中心静脉导管（CVC）和尿管留置时间延长以及在过去30天内接受全胃肠外营养（TPN）被认为是潜在的危险因素。即使在儿童中，产ESBL肠杆菌科细菌感染的威胁也在增加。仔细识别有风险的患者应促进有针对性的干预措施，以减轻ESBL负担。
