Epidemiology of Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumoniae That Are Piperacillin-Tazobactam-Nonsusceptible but Ceftriaxone-Susceptible
Epidemiology of Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumoniae That Are Piperacillin-Tazobactam-Nonsusceptible but Ceftriaxone-Susceptible
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DOI：
10.1093/ofid/ofy300
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发表时间：
2018-12-01
影响因子：
4.2
通讯作者：
Satlin, Michael J.
中科院分区：
文献类型：
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作者：
Baker, Thomas M.;Rogers, Wesley;Satlin, Michael J.
背景非敏感性（TZP-NS）肠杆菌科细菌通常也对头孢曲松耐药。我们最近遇到的细菌感染是由于大肠埃希菌（Ec）和肺炎克雷伯菌（Kp）是TZP-NS，但头孢曲松敏感（CRO-S）。我们回顾了2011年至2015年我们中心的所有Ec和Kp细菌，并评估了TZP-NS/CRO-S感染的患病率、抗菌药物敏感性、遗传特征、患者特征、治疗和结局。我们确定了TZP-NS/CRO-S感染的危险因素，并与Ec和Kp菌群（TZP-S和CRO-S（对照组1））进行了比较，并比较了TZP-NS/CRO-S菌群患者（对照组1）和产超广谱β-内酰胺酶（ESBL）的Ec和Kp菌血症患者的结局。共有1857例Ec和Kp菌血症发作，其中78例（4.2%）为TZP-NS/CRO-S（Ec：50/1227 [4.1%]; Kp：28/630 [4.4%]）。所有TZP-NS/CRO-S分离株也都是氨苄青霉素-舒巴坦-NS。在32株TZP-NS/CRO-S中，28株（88%）携带bla（TEM-1）或bla（SHV-1），无ESBL或AmpC酶基因，且存在多种序列类型。TZP-NS/CRO-S菌血症的独立危险因素是暴露于β-内酰胺/β-内酰胺酶抑制剂（BL/BLI;校正比值比[aOR]，5.5; P
Background. Piperacillin-tazobactam-nonsusceptible (TZP-NS) Enterobacteriaceae are typically also resistant to ceftriaxone. We recently encountered bacteremias due to Escherichia coli (Ec) and Klebsiella pneumoniae (Kp) that were TZP-NS but ceftriaxone- susceptible (CRO-S).Methods. We reviewed all Ec and Kp bacteremias from 2011 to 2015 at our center and assessed the prevalence, antimicrobial susceptibilities, genetic profiles, patient characteristics, treatments, and outcomes of TZP-NS/CRO-S infections. We identified risk factors for TZP-NS/CRO-S infections compared with Ec and Kp bacteremias that were TZP-S and CRO-S (Control Group 1) and compared outcomes of patients with TZP-NS/CRO-S bacteremias, Control Group 1, and patients bacteremic with extended-spectrum beta-lactamase (ESBL)-producing Ec and Kp.Results. There were 1857 Ec and Kp bacteremia episodes, of which 78 (4.2%) were TZP-NS/CRO-S (Ec: 50/1227 [4.1%]; Kp: 28/630 [4.4%]). All TZP-NS/CRO-S isolates were also ampicillin-sulbactam-NS. Of 32 TZP-NS/CRO-S isolates that were sequenced, 28 (88%) harbored bla(TEM-1) or bla(SHV-1), none had an ESBL or AmpC beta-lactamase gene, and many sequence types were represented. Independent risk factors for TZP-NS/CRO-S bacteremia were exposure to beta-lactam/beta-lactamase inhibitors (BL/BLIs; adjusted odds ratio [aOR], 5.5; P