Treatment with Fluoroquinolones or with β-Lactam-β-Lactamase Inhibitor Combinations Is a Risk Factor for Isolation of Extended-Spectrum-β-Lactamase-Producing Klebsiella Species in Hospitalized Patients
Treatment with Fluoroquinolones or with β-Lactam-β-Lactamase Inhibitor Combinations Is a Risk Factor for Isolation of Extended-Spectrum-β-Lactamase-Producing Klebsiella Species in Hospitalized Patients
复制标题
使用氟喹诺酮类药物或 β-内酰胺-β-内酰胺酶抑制剂组合治疗是住院患者中分离产生超广谱-β-内酰胺酶的克雷伯菌属的危险因素
DOI：
10.1128/aac.01131-09
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发表时间：
2010
影响因子：
4.9
通讯作者：
Y. Carmeli
中科院分区：
文献类型：
--
作者：
K. Wener;V. Schechner;H. Gold;S. Wright;Y. Carmeli
抗生素暴露具有很强的选择压力，是抗生素耐药的重要可改变危险因素。我们的目的是确定各种抗生素在三级医院住院患者中作为分离广谱β-内酰胺酶（ESBL）产生克雷伯氏菌的危险因素的作用。建立了一个平行多变量模型，将医院获得性ESBL或非ESBL克雷伯氏菌感染两组病例与住院患者的普通对照组进行比较（病例-病例-对照设计）。分析了78例ESBL病例，358例非ESBL病例和444例对照。与克雷伯氏菌分离相关的重要因素是年龄在50 ~ 65岁之间，从医疗机构转院，在重症监护病房（ICU）住院，以及存在合并症恶性肿瘤或肺、肝或肾脏疾病。由此产生倾向评分，我们区分克雷伯菌病例和对照组的能力很好（受试者工作特征曲线下面积，0.78）。ESBL表型与氟喹诺酮类药物耐药密切相关（95% vs 18%, P < 0.001）。在多变量分析中，对倾向评分进行调整后，与ESBL克雷伯氏菌分离相关的因素包括暴露于β-内酰胺-β-内酰胺酶抑制剂组合（比值比[OR]， 10.17； 95%可信区间[CI]， 1.19至86.92）和氟喹诺酮类药物（比值比，2.86;95% CI， 1.37至5.97）。仅在未接受氟喹诺酮类药物治疗的亚组患者中，广谱头孢菌素暴露与ESBL克雷伯氏菌有统计学相关性。在我们的机构中，产ESBL-克雷伯氏菌表型与氟喹诺酮耐药共同选择，氟喹诺酮和β-内酰胺-β-内酰胺酶抑制剂联合使用，而不是头孢菌素，是ESBL分离株的主要危险因素。限制产生esbl的分离株传播的处方干预措施应针对每种情况量身定制。
ABSTRACT Antibiotic exposure exerts strong selective pressure and is an important modifiable risk factor for antibiotic resistance. We aimed to identify the role of various antibiotics as risk factors for the isolation of extended-spectrum-β-lactamase (ESBL)-producing Klebsiella spp. in hospitalized patients at a tertiary-care hospital. A parallel multivariable model was created to compare two groups of cases with either nosocomially acquired ESBL- or non-ESBL-producing Klebsiella spp. to a common control group of hospitalized patients (a case-case-control design). Seventy-eight ESBL cases, 358 non-ESBL cases, and 444 controls were analyzed. Significant factors associated with the isolation of Klebsiella spp. were an age of >65 years, transfer from a health care facility, an intensive care unit (ICU) stay, and the presence of a comorbid malignancy or lung, hepatic, or renal disease. A propensity score was generated from the above, and our ability to discriminate between Klebsiella cases and controls (area under the receiver-operating-characteristic [ROC] curve, 0.78) was good. The ESBL phenotype was tightly linked with fluoroquinolone resistance (95% versus 18%, P < 0.001). Factors associated with isolation of ESBL Klebsiella spp. in a multivariable analysis, adjusting for the propensity score, included exposure to β-lactam-β-lactamase inhibitor combinations (odds ratio [OR], 10.17; 95% confidence interval [CI], 1.19 to 86.92) and to fluoroquinolones (OR, 2.86; 95% CI, 1.37 to 5.97). Exposure to broad-spectrum cephalosporins was statistically associated with ESBL Klebsiella spp. only among the subgroup of patients not treated with fluoroquinolones. In our institution, where the ESBL-producing-Klebsiella phenotype is coselected with fluoroquinolone resistance, fluoroquinolone and β-lactam-β-lactamase inhibitor combinations, rather than cephalosporins, are the main risk factors for ESBL isolates. Formulary interventions to limit the spread of ESBL-producing isolates should be tailored to each setting.