Division of Critical Care Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan 72152, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan.
Department of Medicine, National Cheng Kung University Medical College, Tainan 70403, Taiwan; Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan.
J Microbiol Immunol Infect. 2018 Aug;51(4):519-526. doi: 10.1016/j.jmii.2017.05.006. Epub 2017 Jun 29.
The presence of extended-spectrum β-lactamase (ESBL) in Escherichia coli, Klebsiella species, and Proteus mirabilis (EKP) is of great microbiological and clinical importance. The study dealing with the direct impact of ESBL producers on the outcome of patients with community-onset bacteremia is lacking.
Adults with community-onset EKP bacteremia were recruited retrospectively during a 6-year period. ESBL producers were determined according to ESBL phenotype. ESBL patients were compared on a 1:2 basis with non-ESBL patients by using propensity-score matching (PSM) calculated based on independent predictors of 28-day mortality.
Of the 1141 eligible adult patients, 65 (5.7%) caused by ESBL producers. Significant differences between the two groups were discovered in the proportions of patients with critical illness (a Pitt bacteremia score ≥ 4) at bacteremia onset, inappropriate empirical antibiotic therapy, bacteremia because of urosepsis and pneumonia, and several comorbidities. In a PSM analysis after controlling for six independent predictors-critical illness at bacteremia onset, underlying fatal comorbidities (McCabe classification), inappropriate empirical antibiotic therapy, comorbidities with liver cirrhosis, bacteremia because of urosepsis and pneumonia-a appropriate matching between two groups (ESBL group, 60 patients; non-ESBL group, 120) were observed in age, causative microorganism, bacteremia severity, major comorbidities, comorbidity severity, and major bacteremia source. Consequently, a strong relationship between ESBL producers and poor prognosis was highlighted.
The adverse influence of ESBL producers on clinical outcomes was presented with respect to adults with community-onset EKP bacteremia. Establishing a predictive scoring algorithm for identifying patients at risk of ESBL-producer infections is crucial.
产超广谱β-内酰胺酶（ESBL）的大肠埃希菌、克雷伯菌属和奇异变形杆菌（EKP）具有重要的微生物学和临床意义。目前尚缺乏研究直接探讨 ESBL 产生菌对社区获得性菌血症患者结局的影响。
本研究采用回顾性研究方法，连续纳入 6 年间成人社区获得性 EKP 菌血症患者。根据 ESBL 表型确定 ESBL 产生菌。采用基于 28 天死亡率的独立预测因素的倾向评分匹配（PSM），按 1:2 的比例将 ESBL 患者与非 ESBL 患者进行比较。
在纳入的 1141 例成年患者中，65 例（5.7%）由 ESBL 产生菌引起。两组患者在发病时患有危重病（Pitt 菌血症评分≥4）、经验性抗生素治疗不当、菌血症由尿路感染和肺炎引起以及存在多种合并症的比例方面存在显著差异。在控制了 6 个独立预测因素（发病时的危重病、潜在致命合并症（McCabe 分类）、经验性抗生素治疗不当、合并肝硬化、尿路感染和肺炎引起的菌血症）的 PSM 分析后，两组之间观察到适当的匹配（ESBL 组 60 例；非 ESBL 组 120 例），包括年龄、病原体、菌血症严重程度、主要合并症、合并症严重程度和主要菌血症来源。因此，ESBL 产生菌与不良预后之间存在很强的关系。
ESBL 产生菌对成人社区获得性 EKP 菌血症的临床结局有不良影响。建立预测评分算法识别 ESBL 产生菌感染高危患者至关重要。
