Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain.
Microbiology Department, CatLab, Barcelona, Spain.
Int J Antimicrob Agents. 2017 Aug;50(2):197-202. doi: 10.1016/j.ijantimicag.2017.03.009. Epub 2017 May 24.
The aim of this study was to determine the epidemiology and risk factors associated with community-onset urinary tract infections (CO-UTIs) due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-Kp). A cohort study including all consecutive patients with K. pneumoniae CO-UTI identified from January 2010 to December 2014 was conducted. Patients with CO-UTI due to ESBL-Kp were then included as cases in a retrospective case-control-control study; controls were outpatients with CO-UTI caused by non-ESBL-producing Escherichia coli and K. pneumoniae (non-ESBL-Ec and non-ESBL-Kp, respectively). Each control was matched in a 2:1 ratio according to patient age, sex and year of isolation. Genotyping confirming ESBL was performed by multiplex PCR and sequencing. The prevalence of ESBL-Kp CO-UTIs, calculated among all K. pneumoniae CO-UTIs, increased from 2.4% in 2010 to 10.3% in 2014 (P = 0.01). Among cases, 63.8% were truly community-acquired, and CTX-M-15 was the predominant β-lactamase enzyme type (79.3%). A total of 83 cases and 319 controls were studied. Being a nursing home resident [odds ratio (OR) = 8.8, 95% confidence interval (CI) 2.6-29.4] and previous cephalosporin use (OR = 4.01, 95% CI 1.8-9.2) were risk factors independently associated with CO-UTI due to ESBL-Kp. In conclusion, the prevalence of CO-UTIs due to ESBL-Kp is increasing. In most cases, ESBL-Kp CO-UTIs are community-acquired and produce CTX-M-15 β-lactamase. Exposure to cephalosporins and being a nursing home resident were risk factors associated with ESBL-Kp CO-UTIs. CTX-M-15-producing K. pneumoniae isolates are emerging in the community.
本研究旨在确定产超广谱β-内酰胺酶（ESBL）肺炎克雷伯菌（ESBL-Kp）引起的社区获得性尿路感染（CO-UTI）的流行病学和危险因素。对 2010 年 1 月至 2014 年期间从所有确诊的肺炎克雷伯菌 CO-UTI 患者中进行了一项队列研究。将 ESBL-Kp 引起的 CO-UTI 患者纳入回顾性病例对照对照研究中作为病例；对照组为由非产 ESBL 大肠埃希菌和肺炎克雷伯菌（非产 ESBL-Ec 和非产 ESBL-Kp）引起的 CO-UTI 门诊患者。每个对照组根据患者年龄、性别和分离年份按 2:1 的比例进行匹配。通过多重 PCR 和测序进行 ESBL 确证基因分型。2010 年至 2014 年，所有肺炎克雷伯菌 CO-UTI 中 ESBL-Kp CO-UTI 的患病率从 2.4%增加到 10.3%（P=0.01）。在病例中，63.8%为真正的社区获得性感染，CTX-M-15 是主要的β-内酰胺酶酶型（79.3%）。共研究了 83 例病例和 319 例对照。居住在养老院（比值比 [OR] = 8.8，95%置信区间 [CI] 2.6-29.4）和使用头孢菌素之前（OR = 4.01，95%CI 1.8-9.2）是与 ESBL-Kp 引起的 CO-UTI 相关的独立危险因素。总之，ESBL-Kp 引起的 CO-UTI 的患病率正在增加。在大多数情况下，ESBL-Kp CO-UTI 是社区获得性的，产生 CTX-M-15 型β-内酰胺酶。头孢菌素暴露和居住在养老院是与 ESBL-Kp CO-UTI 相关的危险因素。产 CTX-M-15 的肺炎克雷伯菌分离株正在社区中出现。
