Adult Infectious Diseases Ward, Mahosot Hospital, Vientiane, Laos.
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos.
Am J Trop Med Hyg. 2020 May;102(5):1137-1143. doi: 10.4269/ajtmh.19-0304.
Although there has been an increasing incidence of bacteremia caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) across South East Asia, there are sparse data from the Lao PDR, where laboratory capacity for antimicrobial resistance surveillance is limited. We, therefore, retrospectively reviewed bacteremia caused by ESBL-producing and between 2010 and 2014 at Mahosot Hospital, Vientiane, Lao PDR. Clinical and laboratory data relating to all episodes of ESBL-E bacteremia were reviewed over the 5-year period and compared with non-ESBL-E bacteremia. Blood cultures positive for or were identified retrospectively from laboratory records. Clinical and laboratory data were extracted from research databases and case notes and analyzed using STATA. Between 2010 and 2014, we identified 360 patients with ( = 249) or ( = 111) bacteremia, representing 34.8% of all patients with clinically significant bacteremia Seventy-two (20%) isolates produced ESBL; accounted for 15.3% (55/360) and for 4.7% (17/360), respectively. The incidence of ESBL-producing bacteremia rose during the study period. By multiple logistic analysis, reported antibiotic use in the previous week was significantly associated with ESBL positivity ( < 0.001, odds ratio 3.89). Although multiresistant, most ESBL-producing and remained susceptible to meropenem (65/65; 100%) and amikacin (64/65; 98.5%). We demonstrated an alarming increase in the incidence of ESBL-E as a cause of bacteremia in Vientiane during the study period. This has implications for empiric therapy of sepsis in Laos, and ongoing surveillance is essential.
虽然东南亚产超广谱β-内酰胺酶（ESBL）肠杆菌科（ESBL-E）引起的菌血症发病率不断上升，但老挝人民民主共和国（老挝）的相关数据却很少，因为该国的抗菌药物耐药性监测实验室能力有限。因此，我们回顾性分析了 2010 年至 2014 年期间万象玛霍索医院产 ESBL 和非产 ESBL 的肠杆菌科菌血症患者的临床和实验室数据。在 5 年期间，我们回顾性地从实验室记录中确定了所有产 ESBL-E 菌血症和非产 ESBL-E 菌血症患者的血液培养阳性病例。从研究数据库和病历中提取临床和实验室数据，并使用 STATA 进行分析。2010 年至 2014 年期间，我们共发现 360 例产 （=249 例）或 （=111 例）菌血症患者，占所有有临床意义菌血症患者的 34.8%。72 株（20%）分离株产 ESBL，分别占 15.3%（55/360）和 4.7%（17/360）。产 ESBL 的 菌血症发病率在研究期间呈上升趋势。通过多因素逻辑分析，研究前一周报告的抗生素使用与 ESBL 阳性显著相关（<0.001，优势比 3.89）。尽管耐药性较强，但大多数产 ESBL 的 和 对美罗培南（65/65；100%）和阿米卡星（64/65；98.5%）仍保持敏感。我们的研究结果表明，在研究期间，万象产 ESBL-E 作为菌血症的发病率呈上升趋势，这对抗生素经验性治疗老挝的败血症具有重要意义，因此需要进行持续监测。
