Epidemiology of infections due to extended-spectrum Beta-lactamase-producing bacteria in a pediatric intensive care unit.
Epidemiology of infections due to extended-spectrum Beta-lactamase-producing bacteria in a pediatric intensive care unit.
复制标题
DOI：
10.5863/1551-6776-19.2.83
复制
发表时间：
2014-04-01
期刊：
影响因子：
--
通讯作者：
Lowros, Autumn S
中科院分区：
文献类型：
--
作者：
Benner, Kim W;Prabhakaran, Priya;Lowros, Autumn S
目的：为了确定在儿科重症监护病房（PICU）中由产超广谱SS-内酰胺酶（ESBL）的克雷伯菌属或大肠杆菌革兰氏阴性菌引起的感染的比例，并确定这些感染的危险因素。方法：对5年内因克雷伯菌属或大肠杆菌感染而入住PICU的患者进行回顾性单中心图表审查。收集的数据包括人口统计学，住院时间，结果，和相关的危险因素先前定义的literation.RESULTS：共培养110株从94例患者。共53%的分离株为大肠杆菌，其余为克雷伯氏菌亚种。110株ESBL菌中7例患者13株（11.8%）为ESBL阳性。产ESBL菌株平均分布于大肠埃希菌和克雷伯菌，并从气管吸出物中进行原代培养。大多数ESBL阳性分离株（9/13; 69%）培养自前30天接受头孢他啶和/或头孢噻肟的患者。感染大肠杆菌的患者有较高的PRISM 1评分，更有可能使用Foley导管，而克雷伯氏菌感染在机械通气男性中更常见。虽然没有统计学意义，80%的患者感染非产ESBL微生物存活出院，而57%的感染产ESBL大肠杆菌和克雷伯氏菌。结论：近12%的大肠杆菌和克雷伯氏菌分离株在这个病人群体中检测阳性的ESBL生产。产ESBL在大肠埃希菌和克雷伯菌属之间平均分布。这些微生物来自7%的研究患者。如先前研究所报告，感染产ESBL微生物的患者最常接受头孢菌素治疗，并且在PICU的住院时间较长。
OBJECTIVES: To determine the proportion of infections caused by extended-spectrum SS-lactamase (ESBL)-producing Klebsiella or Escherichia coli Gram-negative organisms in the pediatric intensive care unit (PICU), and to identify risk factors for these infections.METHODS: A retrospective, single-center chart review of patients admitted to a PICU in a 5-year period with infections caused by Klebsiella species or E coli was completed. Data collected include demographics, length of stay, outcome, and relevant risk factors previously defined in the literature.RESULTS: A total of 110 isolates were cultured from 94 patients. A total of 53% of the isolates were E coli, and the remainder were Klebsiella subspecies. Of the 110 isolates, 13 isolates (11.8%) in 7 patients were ESBL positive. The ESBL-producing isolates were equally distributed amongE coli and Klebsiella and were primarily cultured from tracheal aspirates. Most of the ESBL-positive isolates (9 of 13; 69%) were cultured from patients who received ceftazidime and/or cefotaxime in the preceding 30 days. Patients infected with E coli had higher PRISM 1 scores and were more likely to have a Foley catheter, whereas infections with Klebsiella were more common in mechanically ventilated males. Although not statistically significant, 80% of patients who were infected with non-ESBL-producing organisms survived to hospital discharge versus 57% of those infected with ESBL-producing E coli and Klebsiella.CONCLUSIONS: Almost 12% of E coli and Klebsiella isolates in this patient population tested positive for ESBL production. ESBL production was equally distributed between E coli and Klebsiella species. These organisms were cultured from 7% of the study patients. As reported in previous studies, patients infected with ESBL-producing organisms most often had received prior cephalosporins and had a longer length of stay in the PICU.