CTX-M ESBL-producing Enterobacteriaceae: estimated prevalence in adults in England in 2014
CTX-M ESBL-producing Enterobacteriaceae: estimated prevalence in adults in England in 2014
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DOI：
10.1093/jac/dky007
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发表时间：
2018-05-01
影响因子：
5.2
通讯作者：
Hawkey, Peter M.
中科院分区：
文献类型：
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作者：
McNulty, Cliodna A. M.;Lecky, Donna M.;Hawkey, Peter M.
背景：产ESBL-Enterobacteriaceae（ESBLPE）在全球范围内的流行率正在增加，并且比非ESBLPE更难治疗。其在英国普通人群中的患病率尚不清楚，因为之前唯一的英国ESBLPE粪便定植研究涉及腹泻患者。目的：估计2014年英国普通成人人群中CTX-M ESBLPE粪便定植的患病率，并调查风险因素。方法：分层随机抽样的58337例登记患者从16个一般的做法在英格兰的四个地区被邀请参加返回粪便标本和自我完成的问卷调查。标本进行了测试ESBLPE和产碳青霉烯酶肠杆菌科（CPE）。结果：2430人参加（4%的邀请）。在英格兰，CTX-M ESBLPE定植的估计患病率为7.3%（95% CI 5.6%-9.4%）（什罗普郡774名参与者，4.9%殖民化;南安普顿市740名参与者，9.2%;纽汉612名参与者，12.7%;伯明翰市中心234名参与者，16.0%），并且在以下方面特别高：在阿富汗出生的人（10例受试者，60.0%殖民，95% CI 29.7%-84.2%）;出生于印度次大陆的受试者（印度、巴基斯坦、孟加拉国或斯里兰卡）（259例受试者，25.0%定植，95% CI 18.5%-32.9%）;前往南亚的旅客（印度、巴基斯坦、孟加拉国、斯里兰卡或尼泊尔）（140名参与者，38.5%定植，95% CI 27.8%-50.5%）;和医疗保健患者（8名参与者，未加权37.5%定植，95% CI 8.5%-75.5%）。确定的风险因素包括：出生在印度次大陆（aOR 5.4，95% CI 3.0-9.7）;前往南亚（aOR 2.9，95% CI 1.8-4.8）或非洲、中国、南美洲或中美洲、东南亚或太平洋亚洲或阿富汗（aOR 2.6，95% CI 1.7-4.1）;以及作为医疗保健家庭（aOR 6.2，95% CI 1.3-31）。去年服用co-amoxiclav的48名参与者中没有一人被CTX-M ESBLPE定殖。bla（CTX-M-15）占CTX-M ESBLPE阳性的66%。0.1%（两名参与者）与CPE.Conclusions：CTX-M ESBLPE建立在英格兰的一般人群中，患病率特别高，在某些国家的出生或最近旅行的人。我们建议，在指导经验性管理可能存在肠杆菌科感染的患者时，应考虑这些发现。
Background: ESBL-producing Enterobacteriaceae (ESBLPE) are increasing in prevalence worldwide and are more difficult to treat than non-ESBLPE. Their prevalence in the UK general population is unknown, as the only previous UK ESBLPE faecal colonization study involved patients with diarrhoea.Objectives: To estimate the prevalence of CTX-M ESBLPE faecal colonization in the general adult population of England in 2014, and investigate risk factors.Methods: A stratified random sample of 58337 registered patients from 16 general practices within four areas of England were invited to participate by returning faeces specimens and self-completed questionnaires. Specimens were tested for ESBLPE and carbapenemase-producing Enterobacteriaceae (CPE).Results: 2430 individuals participated (4% of those invited). The estimated prevalence of colonization with CTX-M ESBLPE in England was 7.3% (95% CI 5.6%-9.4%) (Shropshire 774 participants, 4.9% colonization; Southampton City 740 participants, 9.2%; Newham 612 participants, 12.7%; Heart of Birmingham 234 individuals, 16.0%) and was particularly high in: those born in Afghanistan (10 participants, 60.0% colonization, 95% CI 29.7%-84.2%); those born on the Indian subcontinent (India, Pakistan, Bangladesh or Sri Lanka) (259 participants, 25.0% colonization, 95% CI 18.5%-32.9%); travellers to South Asia (India, Pakistan, Bangladesh, Sri Lanka or Nepal) in the last year (140 participants, 38.5% colonization, 95% CI 27.8%-50.5%); and healthcare domestics (8 participants, unweighted 37.5% colonization, 95% CI 8.5%-75.5%). Risk factors identified included: being born in the Indian subcontinent (aOR 5.4, 95% CI 3.0-9.7); travel to South Asia (aOR 2.9, 95% CI 1.8-4.8) or to Africa, China, South or Central America, South East or Pacific Asia or Afghanistan (aOR 2.6, 95% CI 1.7-4.1) in the last year; and working as a healthcare domestic (aOR 6.2, 95% CI 1.3-31). None of the 48 participants who took co-amoxiclav in the last year was colonized with CTX-M ESBLPE. bla(CTX-M-15) accounted for 66% of CTX-M ESBLPE positives. 0.1% (two participants) were colonized with CPE.Conclusions: CTX-M ESBLPE are established in the general population in England and prevalence is particularly high in people from certain countries of birth or with recent travel. We recommend that these findings be taken into account in guidance on the empirical management of patients presenting with a likely Enterobacteriaceae infection.