Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2024 May 15;78(5):1103-1110. doi: 10.1093/cid/ciad703.
Investigations into antibiotics for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infections (BSIs) have focused on blaCTX-M genes. Patient outcomes from non-CTX-M-producing ESBL-E BSIs and optimal treatment are unknown.
A multicenter observational study investigating 500 consecutive patients with ceftriaxone-resistant Enterobacterales BSIs during 2018-2022 was conducted. Broth microdilution and whole-genome sequencing confirmed antibiotic susceptibilities and ESBL gene presence, respectively. Inverse probability weighting (IPW) using propensity scores ensured patients with non-CTX-M and CTX-M ESBL-E BSIs were similar before outcome evaluation.
396 patients (79.2%) were confirmed to have an ESBL-E BSI. ESBL gene family prevalence was as follows: blaCTX-M (n = 370), blaSHV (n = 16), blaOXY (n = 12), and blaVEB (n = 5). ESBL gene identification was not limited to Escherichia coli and Klebsiella species. In the IPW cohort, there was no difference in 30-day mortality or ESBL-E infection recurrence between the non-CTX-M and CTX-M groups (odds ratio [OR], 0.99; 95% confidence interval [CI], .87-1.11; P = .83 and OR, 1.10; 95% CI, .85-1.42; P = .47, respectively). In an exploratory analysis limited to the non-CTX-M group, 86% of the 21 patients who received meropenem were alive on day 30; none of the 5 patients who received piperacillin-tazobactam were alive on day 30.
Our findings suggest that non-CTX-M and CTX-M ESBL-E BSIs are equally concerning and associated with similar clinical outcomes. Meropenem may be associated with improved survival in patients with non-CTX-M ESBL-E BSIs, underscoring the potential benefit of comprehensive molecular diagnostics to enable early antibiotic optimization for ESBL-E BSIs beyond just blaCTX-M genes.
对产超广谱β-内酰胺酶肠杆菌科（ESBL-E）血流感染（BSI）的抗生素研究集中在 blaCTX-M 基因上。非 CTX-M 产 ESBL-E BSI 患者的预后和最佳治疗方法尚不清楚。
对 2018 年至 2022 年间 500 例头孢曲松耐药肠杆菌科 BSI 患者进行了一项多中心观察性研究。肉汤微量稀释法和全基因组测序分别确认了抗生素敏感性和 ESBL 基因的存在。使用倾向评分进行逆概率加权（IPW），以确保在结果评估前非 CTX-M 和 CTX-M ESBL-E BSI 患者具有相似的特征。
396 例患者（79.2%）被确诊为 ESBL-E BSI。ESBL 基因家族的流行率如下：blaCTX-M（n = 370）、blaSHV（n = 16）、blaOXY（n = 12）和 blaVEB（n = 5）。ESBL 基因的鉴定并不仅限于大肠埃希菌和肺炎克雷伯菌。在 IPW 队列中，非 CTX-M 和 CTX-M 组之间 30 天死亡率或 ESBL-E 感染复发率无差异（比值比 [OR]，0.99；95%置信区间 [CI]，.87-1.11；P =.83 和 OR，1.10；95%CI，.85-1.42；P =.47，分别）。在仅限于非 CTX-M 组的探索性分析中，接受美罗培南治疗的 21 例患者中有 86%在第 30 天存活；接受哌拉西林-他唑巴坦治疗的 5 例患者中无一例在第 30 天存活。
我们的研究结果表明，非 CTX-M 和 CTX-M ESBL-E BSI 同样令人担忧，且与相似的临床结局相关。非 CTX-M ESBL-E BSI 患者接受美罗培南治疗可能与生存率提高相关，这突显了全面分子诊断的潜在益处，可在 blaCTX-M 基因之外，优化针对 ESBL-E BSI 的早期抗生素治疗。
