Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
Division of Bacteriology and Mycology, University Hospital Basel, University Basel, Basel, Switzerland.
Swiss Med Wkly. 2024 Oct 9;154:3904. doi: 10.57187/s.3904.
Aminoglycoside resistance is frequently detected in extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE), questioning the appropriateness of aminoglycosides as empiric therapy in patients with suspected ESBL-PE infections. Therefore, we aimed to evaluate the frequency of aminoglycoside resistance in patients harbouring ESBL-PE and identify patient-related risk factors associated with aminoglycoside resistance to facilitate early detection of at-risk patients.
This retrospective single-centre cohort study included hospitalised patients aged ≥18 years with an ESBL-PE-positive sample between January 2016 and December 2018. Aminoglycoside resistance was defined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints for Enterobacterales for the current year of testing.
Five hundred forty-four patients met the eligibility criteria, of which 240 (44.1%) harboured aminoglycoside-resistant ESBL strains. Identification of ESBL-Klebsiella pneumoniae was significantly associated with aminoglycoside resistance (odds ratio [OR] = 2.64, 95% confidence interval [CI] = 1.65-4.21, p <0.001) and an international travel history within the past 12 months was marginally associated with aminoglycoside resistance (OR = 1.51, 95% CI = 0.95-2.42, p = 0.084).
In a low ESBL endemicity setting, aminoglycoside resistance in patients harbouring ESBL-PE is common, especially ESBL-K. pneumoniae, and needs to be considered in clinicians' decision-making regarding empiric therapy regimens.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌（ESBL-PE）常出现氨基糖苷类耐药，这使得氨基糖苷类药物作为疑似 ESBL-PE 感染患者经验性治疗的合理性受到质疑。因此，本研究旨在评估携带 ESBL-PE 的患者中氨基糖苷类耐药的频率，并确定与氨基糖苷类耐药相关的患者相关危险因素，以帮助早期发现高危患者。
这是一项回顾性单中心队列研究，纳入了 2016 年 1 月至 2018 年 12 月期间年龄≥18 岁且 ESBL-PE 阳性样本的住院患者。根据当年的欧洲抗菌药物敏感性试验委员会（EUCAST）肠杆菌科临床折点定义氨基糖苷类耐药。
符合入选标准的患者共 544 例，其中 240 例（44.1%）携带氨基糖苷类耐药的 ESBL 株。ESBL-肺炎克雷伯菌的鉴定与氨基糖苷类耐药显著相关（比值比[OR] = 2.64，95%置信区间[CI] = 1.65-4.21，p <0.001），而过去 12 个月内的国际旅行史与氨基糖苷类耐药呈边缘相关（OR = 1.51，95%CI = 0.95-2.42，p = 0.084）。
在低 ESBL 流行地区，携带 ESBL-PE 的患者中氨基糖苷类耐药很常见，尤其是 ESBL-肺炎克雷伯菌，这需要临床医生在制定经验性治疗方案时考虑。
