Richelsen Rasmus, Smit Jesper, Schønheyder Henrik Carl, Laxsen Anru Pavithra, Gutiérrez-Gutiérrez Belen, Rodríguez-Bãno Jesús, Nielsen Henrik
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Antimicrob Chemother. 2020 Dec 1;75(12):3656-3664. doi: 10.1093/jac/dkaa361.
To assess the impact of ESBL production on mortality and length of hospital stay (LOS) of community-onset infections due to Escherichia coli or Klebsiella pneumoniae.
A population-based cohort study including all adult patients hospitalized with a first-time community-onset E. coli or K. pneumoniae bacteraemia or urinary tract infection in the North Denmark Region between 2007 and 2017. For each bacterial agent, we computed 1 year Kaplan-Meier survival curves and cumulative incidence functions of LOS, and by use of Cox proportional hazard regression we computed HRs as estimates of 30 day and 1 year mortality rate ratios (MRRs) and LOS among patients with and without ESBL-producing infections.
We included 24 518 cases (among 22350 unique patients), of whom 1018 (4.2%) were infected by an ESBL-producing bacterium. The 30 day cumulative mortality and adjusted MRR (aMRR) in patients with and without ESBL-producing isolates was as follows: E. coli bacteraemia (n = 3831), 15.8% versus 14.0%, aMRR = 1.01 (95% CI = 0.70-1.45); E. coli urinary tract infection (n = 17151), 9.5% versus 8.7%, aMRR = 0.97 (95% CI = 0.75-1.26); K. pneumoniae bacteraemia (n = 734), 0% versus 17.2%, aMRR = not applicable; and K. pneumoniae urinary tract infection (n = 2802), 13.8% versus 10.7%, aMRR = 1.13 (95% CI = 0.73-1.75). The 1 year aMRR remained roughly unchanged. ESBL-producing E. coli bacteraemia was associated with an increased LOS compared with non-ESBL production.
ESBL production was not associated with an increased short- or long-term mortality in community-onset infections due to E. coli or K. pneumoniae, yet ESBL-producing E. coli bacteraemia was associated with an increased LOS.
评估产超广谱β-内酰胺酶（ESBL）对大肠埃希菌或肺炎克雷伯菌所致社区获得性感染患者死亡率及住院时间（LOS）的影响。
一项基于人群的队列研究，纳入2007年至2017年间在丹麦北部地区首次因社区获得性大肠埃希菌或肺炎克雷伯菌菌血症或尿路感染住院的所有成年患者。对于每种细菌病原体，我们计算了1年的Kaplan-Meier生存曲线和LOS的累积发病率函数，并使用Cox比例风险回归计算风险比（HR），作为产ESBL感染患者与未产ESBL感染患者30天和1年死亡率比（MRR）及LOS的估计值。
我们纳入了24518例病例（来自22350例不同患者），其中1018例（4.2%）感染了产ESBL的细菌。产ESBL菌株与未产ESBL菌株的患者30天累积死亡率及调整后的MRR如下：大肠埃希菌菌血症（n = 3831），分别为15.8%和14.0%，aMRR = 1.01（95%CI = 0.70 - 1.45）；大肠埃希菌尿路感染（n = 17151），分别为9.5%和8.7%，aMRR = 0.97（95%CI = 0.75 - 1.26）；肺炎克雷伯菌菌血症（n = 734），分别为0%和17.2%，aMRR不适用；肺炎克雷伯菌尿路感染（n = 2802），分别为13.8%和10.7%，aMRR = 1.13（95%CI = 0.73 - 1.75）。1年aMRR大致保持不变。与非产ESBL的大肠埃希菌菌血症相比，产ESBL的大肠埃希菌菌血症与LOS延长相关。
产ESBL与大肠埃希菌或肺炎克雷伯菌所致社区获得性感染的短期或长期死亡率增加无关，但产ESBL的大肠埃希菌菌血症与LOS延长相关。
