Stone Tyler J, DeWitt Michael, Johnson James W, Beardsley James R, Munawar Iqra, Palavecino Elizabeth, Luther Vera P, Ohl Christopher A, Williamson John C
Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Antimicrob Steward Healthc Epidemiol. 2023 Mar 8;3(1):e47. doi: 10.1017/ash.2022.363. eCollection 2023.
Among patients with a history of ESBL infection, uncertainty remains regarding whether all of these patients require ESBL-targeted therapy when presenting with a subsequent infection. We sought to determine the risks associated with a subsequent ESBL infection to help inform empiric antibiotic decisions.
A retrospective cohort study of adult patients with positive index culture for or (EC/KP) receiving medical care during 2017 was conducted. Risk assessments were performed to identify factors associated with subsequent infection caused by ESBL-producing EC/KP.
In total, 200 patients were included in the cohort, 100 with ESBL-producing EC/KP and 100 with ESBL-negative EC/KP. Of 100 patients (50%) who developed a subsequent infection, 22 infections were ESBL-producing EC/KP, 43 were other bacteria, and 35 had no or negative cultures. Subsequent infection caused by ESBL-producing EC/KP only occurred when the index culture was also ESBL-producing (22 vs 0). Among those with ESBL-producing index culture, the incidences of subsequent infection caused by ESBL-producing EC/KP versus other bacterial subsequent infection were similar (22 vs 18; = .428). Factors associated with subsequent infection caused by ESBL-producing EC/KP include history of ESBL-producing index culture, time ≤180 days between index culture and subsequent infection, male sex, and Charlson comorbidity index score >3.
History of ESBL-producing EC/KP culture is associated with subsequent infection caused by ESBL-producing EC/KP, particularly within 180 days after the historical culture. Among patients presenting with infection and a history of ESBL-producing EC/KP, other factors should be considered in making empiric antibiotic decisions, and ESBL-targeted therapy may not always be warranted.
在有超广谱β-内酰胺酶（ESBL）感染病史的患者中，对于所有这些患者在出现后续感染时是否都需要进行针对ESBL的治疗仍存在不确定性。我们试图确定与后续ESBL感染相关的风险，以帮助指导经验性抗生素决策。
对2017年期间接受医疗护理且首次培养为大肠埃希菌或肺炎克雷伯菌（EC/KP）呈阳性的成年患者进行了一项回顾性队列研究。进行风险评估以确定与产ESBL的EC/KP引起的后续感染相关的因素。
该队列共纳入200例患者，其中100例为产ESBL的EC/KP，100例为ESBL阴性的EC/KP。在发生后续感染的100例患者（50%）中，22例感染为产ESBL的EC/KP，43例为其他细菌，35例培养结果为无或阴性。产ESBL的EC/KP引起的后续感染仅在首次培养也为产ESBL时发生（22例 vs 0例）。在首次培养为产ESBL的患者中，产ESBL的EC/KP引起的后续感染与其他细菌引起的后续感染发生率相似（22例 vs 18例；P = 0.428）。与产ESBL的EC/KP引起的后续感染相关的因素包括产ESBL的首次培养病史、首次培养与后续感染之间的时间≤180天、男性以及Charlson合并症指数评分>3。
产ESBL的EC/KP培养病史与产ESBL的EC/KP引起的后续感染相关，特别是在既往培养后的180天内。在有感染且有产ESBL的EC/KP病史的患者中，在做出经验性抗生素决策时应考虑其他因素，并非总是需要进行针对ESBL的治疗。
