产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）感染相关的不良临床结局：一项系统评价和荟萃分析
Adverse clinical outcomes associated with infections by Enterobacterales producing ESBL (ESBL-E): a systematic review and meta-analysis.
作者信息
Ling Weiping, Furuya-Kanamori Luis, Ezure Yukiko, Harris Patrick N A, Paterson David L
机构信息
Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia.
Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia.
出版信息
JAC Antimicrob Resist. 2021 Jun 2;3(2):dlab068. doi: 10.1093/jacamr/dlab068. eCollection 2021 Jun.
OBJECTIVES
Enterobacterales producing ESBL (ESBL-E) have been notable for their rapid expansion in community settings. This systematic review and meta-analysis aimed to summarize evidence investigating the association between ESBL-E infection and adverse clinical outcomes, defined as bacteraemia, sepsis or septic shock, and all-cause mortality in adult patients.
METHODS
Database search was conducted in PubMed, Scopus and EMBASE. In general, studies were screened for effect estimates of ESBL-E colonization or infection on clinical outcomes with non-ESBL-producing Enterobacterales as comparator, adult populations and molecular ascertainment of ESBL gene. Meta-analysis was performed using the inverse variance heterogeneity model.
RESULTS
Eighteen studies were identified, including 1399 ESBL-E and 3200 non-ESBL-E infected patients. Sixteen of these studies included only bacteraemic patients. Mortality was studied in 17 studies and ESBL-E infection was significantly associated with higher odds of mortality compared with non-ESBL-producing Enterobacterales infection (OR = 1.70, 95% CI: 1.15-2.49, =58.3%). However, statistical significance did not persist when adjusted estimates were pooled (aOR = 1.67, 95% CI: 0.52-5.39, =78.1%). Septic shock was studied in seven studies and all included only bacteraemic patients. No association between ESBL-E infection and shock was found (OR = 1.23, 95% CI: 0.75-2.02, =14.8%). Only one study investigated the association between ESBL-E infection and bacteraemia.
CONCLUSIONS
Infections by ESBL-E appear to be significantly associated with mortality but not septic shock. Available studies investigating bacteraemia and shock as an intermediate outcome of ESBL-E infections are lacking. Future studies investigating the relationship between clinical outcomes and molecular characteristics of resistant strains are further warranted, along with studies investigating this in non-bacteraemic patients.
目的
产超广谱β-内酰胺酶（ESBL）的肠杆菌目细菌（ESBL-E）在社区环境中的迅速传播已引起关注。本系统评价和荟萃分析旨在总结有关ESBL-E感染与不良临床结局（定义为菌血症、脓毒症或脓毒性休克）以及成年患者全因死亡率之间关联的研究证据。
方法
在PubMed、Scopus和EMBASE数据库中进行检索。总体而言，筛选以不产ESBL的肠杆菌目细菌作为对照、针对成年人群以及对ESBL基因进行分子鉴定的研究，以评估ESBL-E定植或感染对临床结局的影响。采用逆方差异质性模型进行荟萃分析。
结果
共纳入18项研究，包括1399例ESBL-E感染患者和3200例非ESBL-E感染患者。其中16项研究仅纳入了菌血症患者。17项研究对死亡率进行了分析，结果显示与非产ESBL的肠杆菌目细菌感染相比，ESBL-E感染与更高的死亡几率显著相关（OR = 1.70，95%CI：1.15 - 2.49，I² = 58.3%）。然而，合并调整后的估计值时，统计学显著性未持续存在（校正OR = 1.67，95%CI：0.52 - 5.39，I² = 78.1%）。7项研究对脓毒性休克进行了分析，所有研究均仅纳入菌血症患者。未发现ESBL-E感染与休克之间存在关联（OR = 1.23，95%CI：0.75 - 2.02，I² = 14.8%）。仅有1项研究调查了ESBL-E感染与菌血症之间的关联。
结论
ESBL-E感染似乎与死亡率显著相关，但与脓毒性休克无关。目前缺乏将菌血症和休克作为ESBL-E感染中间结局的研究。未来有必要进一步开展研究，以探讨临床结局与耐药菌株分子特征之间的关系，以及在非菌血症患者中的情况。
Zotero 插件