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产AmpC肠杆菌科细菌引起的血流感染:危险因素与治疗结果

Bloodstream Infections by AmpC-Producing Enterobacterales: Risk Factors and Therapeutic Outcome.

作者信息

Pospišil Mladen, Car Haris, Elveđi-Gašparović Vesna, Beader Nataša, Herljević Zoran, Bedenić Branka

机构信息

Krapina-Zagorje County Community Health Centre, 49245 Stubica, Croatia.

Zagreb Health School, 10000 Zagreb, Croatia.

出版信息

Pathogens. 2023 Sep 3;12(9):1125. doi: 10.3390/pathogens12091125.

Abstract

Bloodstream infections associated with AmpC-producing Enterobacterales are severe medical conditions which, without prompt and effective treatment, may have dire ramifications. This study aimed to assess whether certain comorbidities and previous surgical procedures coincide with resistance determinants of AmpC-producing Enterobacterales associated with bloodstream infections. Antibiotic resistance patterns and therapy outcome were also determined. The patients' data obtained revealed that the prevalence of recent surgical procedures, solid organ tumors, metabolic diseases, kidney and liver failure, and hematological malignancies do not differ between resistant and susceptible isolates of AmpC-producing Enterobacterales. Furthermore, no difference was reported in mortality rates. Regarding antibiotic resistance, 34.52% of isolates were confirmed to be resistant (AmpC hyperproduction, ESBL, or carbapenemase). More than one in five AmpC hyperproducers were reported amid spp., , , and strains. Carbapenemases were mostly noted in spp. followed by and strains. had the highest proportion of ESBLsof ESBLs. Resistance to expanded-spectrum cephalosporins of spp. and strains exceeded 50%, and resistance to meropenem over 10% was observed only in strains. Enterobacterales' ever-growing resistance to antibiotics is becoming quite a challenge for clinicians and new treatment options are required.

摘要

与产AmpC肠杆菌科细菌相关的血流感染是严重的医学状况,若不及时进行有效治疗,可能会产生可怕的后果。本研究旨在评估某些合并症和既往手术操作是否与产AmpC肠杆菌科细菌血流感染的耐药决定因素相符。同时还确定了抗生素耐药模式和治疗结果。所获得的患者数据显示,近期手术操作、实体器官肿瘤、代谢性疾病、肾衰竭和肝衰竭以及血液系统恶性肿瘤的患病率在产AmpC肠杆菌科细菌的耐药菌株和敏感菌株之间并无差异。此外,死亡率也没有差异。关于抗生素耐药性,34.52%的分离株被证实耐药(AmpC高产量、超广谱β-内酰胺酶或碳青霉烯酶)。在阴沟肠杆菌、产气肠杆菌、弗劳地柠檬酸杆菌和肺炎克雷伯菌菌株中,超过五分之一的菌株为AmpC高产量菌株。碳青霉烯酶大多在肺炎克雷伯菌菌株中发现,其次是阴沟肠杆菌和产气肠杆菌菌株。肺炎克雷伯菌的超广谱β-内酰胺酶比例最高。阴沟肠杆菌和产气肠杆菌菌株对广谱头孢菌素的耐药率超过50%,仅在肺炎克雷伯菌菌株中观察到对美罗培南的耐药率超过10%。肠杆菌科细菌对抗生素的耐药性不断增加,这对临床医生来说是一个相当大的挑战,需要新的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d7de/10535069/9c4d89a5a0a9/pathogens-12-01125-g001.jpg

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