Namikawa Hiroki, Yamada Koichi, Fujimoto Hiroki, Oinuma Ken-Ichi, Tochino Yoshihiro, Takemoto Yasuhiko, Kaneko Yukihiro, Shuto Taichi, Kakeya Hiroshi
Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Japan.
Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, Japan.
Intern Med. 2017;56(14):1807-1815. doi: 10.2169/internalmedicine.56.7702. Epub 2017 Jul 15.
Objective In recent years, infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms has become an important issue. However, comparative studies of the bacteremia caused by ESBL Enterobacteriaceae and non-ESBL Enterobacteriaceae are extremely rare in Japan. This study aimed to assess the risk factors and prognosis of patients with bacteremia due to ESBL Escherichia coli (E. coli). Methods The medical records of 31 patients with ESBL E. coli bacteremia and 98 patients with non-ESBL E. coli bacteremia who had been admitted to Osaka City University Hospital between January 2011 and June 2015 were retrospectively reviewed. The patient backgrounds, risk factors for infection, and prognosis were evaluated. Results The male-to-female ratio, mean age, underlying disease, leukocyte count, and C-reactive protein (CRP) level did not differ between the patients in the ESBL E. coli bacteremia and non-ESBL E. coli bacteremia groups. The mean Sequential Organ Failure Assessment (SOFA) score for patients with ESBL and non-ESBL E. coli bacteremia were 3.6 and 3.8, respectively. Further, the mortality did not differ between the two groups (9.7% vs 9.2%). However, the independent predictors associated with ESBL E. coli bacteremia according to a multivariate analysis were the use of immunosuppressive drugs or corticosteroids (p=0.048) and quinolones (p=0.005) prior to isolation. The mortality did not differ between the carbapenem and tazobactam/piperacillin (TAZ/PIPC) or cefmetazole (CMZ) groups for the patients with ESBL E. coli bacteremia. Conclusion Whenever we encountered patients with a history of immunosuppressive drug, corticosteroid, quinolone administration, it was necessary to perform antibiotic therapy while keeping the risk of ESBL E. coli in mind.
目的 近年来，产超广谱β-内酰胺酶（ESBL）微生物引起的感染已成为一个重要问题。然而，在日本，关于ESBL肠杆菌科细菌和非ESBL肠杆菌科细菌所致菌血症的比较研究极为罕见。本研究旨在评估ESBL大肠埃希菌（大肠杆菌）所致菌血症患者的危险因素及预后。方法 回顾性分析2011年1月至2015年6月期间入住大阪市立大学医院的31例ESBL大肠杆菌菌血症患者和98例非ESBL大肠杆菌菌血症患者的病历。评估患者的背景、感染危险因素及预后。结果 ESBL大肠杆菌菌血症组和非ESBL大肠杆菌菌血症组患者的男女比例、平均年龄、基础疾病、白细胞计数及C反应蛋白（CRP）水平无差异。ESBL和非ESBL大肠杆菌菌血症患者的平均序贯器官衰竭评估（SOFA）评分分别为3.6和3.8。此外，两组的死亡率无差异（9.7%对9.2%）。然而，多因素分析显示，与ESBL大肠杆菌菌血症相关的独立预测因素为隔离前使用免疫抑制药物或皮质类固醇（p=0.048）及喹诺酮类药物（p=0.005）。对于ESBL大肠杆菌菌血症患者，碳青霉烯类与他唑巴坦/哌拉西林（TAZ/PIPC）或头孢美唑（CMZ）组的死亡率无差异。结论 当遇到有免疫抑制药物、皮质类固醇、喹诺酮类药物使用史的患者时，有必要在考虑ESBL大肠杆菌感染风险的同时进行抗生素治疗。
