1Department of Internal Medicine,University of Iowa,Iowa City,Iowa.
2Iowa City Veteran Affairs Medical Center,Iowa City,Iowa.
Infect Control Hosp Epidemiol. 2017 Oct;38(10):1209-1215. doi: 10.1017/ice.2017.156. Epub 2017 Jul 31.
BACKGROUND Despite a reported worldwide increase, the incidence of extended-spectrum β-lactamase (ESBL) Escherichia coli and Klebsiella infections in the United States is unknown. Understanding the incidence and trends of ESBL infections will aid in directing research and prevention efforts. OBJECTIVE To perform a literature review to identify the incidence of ESBL-producing E. coli and Klebsiella infections in the United States. DESIGN Systematic literature review. METHODS MEDLINE via Ovid, CINAHL, Cochrane library, NHS Economic Evaluation Database, Web of Science, and Scopus were searched for multicenter (≥2 sites), US studies published between 2000 and 2015 that evaluated the incidence of ESBL-E. coli or ESBL-Klebsiella infections. We excluded studies that examined resistance rates alone or did not have a denominator that included uninfected patients such as patient days, device days, number of admissions, or number of discharges. Additionally, articles that were not written in English, contained duplicated data, or pertained to ESBL organisms from food, animals, or the environment were excluded. RESULTS Among 51,419 studies examined, 9 were included for review. Incidence rates differed by patient population, time, and ESBL definition and ranged from 0 infections per 100,000 patient days to 16.64 infections per 10,000 discharges and incidence rates increased over time from 1997 to 2011. Rates were slightly higher for ESBL-Klebsiella infections than for ESBL-E. coli infections. CONCLUSION The incidence of ESBL-E. coli and ESBL-Klebsiella infections in the United States has increased, with slightly higher rates of ESBL-Klebsiella infections. Appropriate estimates of ESBL infections when coupled with other mechanisms of resistance will allow for the appropriate targeting of resources toward research, drug discovery, antimicrobial stewardship, and infection prevention. Infect Control Hosp Epidemiol 2017;38:1209-1215.
尽管据报道全球范围内产超广谱β-内酰胺酶（ESBL）大肠埃希菌和肺炎克雷伯菌感染有所增加，但美国的 ESBL 感染发生率尚不清楚。了解 ESBL 感染的发生率和趋势有助于指导研究和预防工作。目的：进行文献复习以确定美国产 ESBL 大肠埃希菌和肺炎克雷伯菌感染的发生率。设计：系统文献复习。方法：通过 Ovid MEDLINE、CINAHL、 Cochrane 图书馆、NHS 经济评价数据库、Web of Science 和 Scopus 检索了 2000 年至 2015 年间发表的、评估 ESBL-E. coli 或 ESBL-肺炎克雷伯菌感染发生率的多中心（≥2 个地点）美国研究。我们排除了仅研究耐药率或没有包括未感染患者（如患者天数、器械天数、入院人数或出院人数）的分母的研究。此外，还排除了那些不是用英文撰写、包含重复数据或与食物、动物或环境中的 ESBL 生物体有关的文章。结果：在检查的 51419 项研究中，有 9 项研究被纳入综述。发病率因患者人群、时间和 ESBL 定义而异，范围从每 100000 患者天 0 例感染到每 10000 出院患者 16.64 例感染，且发病率从 1997 年至 2011 年逐渐增加。ESBL-肺炎克雷伯菌感染的发生率略高于 ESBL-大肠埃希菌感染。结论：美国产 ESBL-大肠埃希菌和肺炎克雷伯菌感染的发生率有所增加，ESBL-肺炎克雷伯菌感染的发生率略高。当与其他耐药机制相结合时，对 ESBL 感染的适当估计将使资源能够适当针对研究、药物发现、抗菌药物管理和感染预防进行靶向。感染控制与医院流行病学 2017；38:1209-1215。
