Community-Onset Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli: Risk Factors and Prognosis
Community-Onset Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli: Risk Factors and Prognosis
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DOI：
10.1086/649537
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发表时间：
2010-01-01
影响因子：
11.8
通讯作者：
Pascual, Alvaro
中科院分区：
文献类型：
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作者：
Rodriguez-Bano, Jesus;Picon, Encarnacion;Pascual, Alvaro
背景产超广谱β-内酰胺酶（ESBL）大肠埃希菌（ESBLEC）引起的社区发病性血流感染（COBSI）的临床资料很少。我们调查了ESBLEC引起COBSI的患病率和危险因素，描述了其临床特征和ESBLEC引起COBSI对14天死亡率的影响。采用多中心病例-对照-对照研究评估危险因素。研究了产ESBL对所有大肠杆菌所致COBSI患者死亡率的影响。杆菌对分离株和ESBLs进行微生物学特征分析。使用多变量逻辑回归进行统计分析。十三个三级保健西班牙医院参加了这项研究。ESBLEC所致COBSI 95例，占同期大肠埃希菌所致COBSI的7.3%。杆菌其中83例（87%）ESBL属于ESBL的CTX-M家族，且大多数与克隆无关。与两个对照组的比较显示，医疗保健（比值比[OR]，2.1; 95%置信区间[CI]，1.2-3.8）、导尿管使用（OR，3.1; 95% CI，1.5-6.5）和既往抗菌药物使用（OR，2.7; 95% CI，1.5-4.9）是ESBLEC导致COBSI的独立风险因素。ESBLEC导致的COBSI患者中，接受β-内酰胺类/β-内酰胺类抑制剂组合或碳青霉烯类经验性治疗的患者的死亡率（8%-12%）低于接受头孢菌素类或氟喹诺酮类药物治疗的患者（分别为24%和29%）。E.大肠埃希菌感染与不适当的经验性治疗有关，而与产ESBL无关。ESBLEC是引起COBSI的一个重要原因。杆菌临床医生应考虑对有危险因素的患者进行足够的经验治疗，并覆盖这些病原体。
Background. There is little clinical information about community-onset bloodstream infections (COBSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC). We investigated the prevalence and risk factors for COBSI due to ESBLEC, and described their clinical features and the impact of COBSI caused by ESBLEC on 14-day mortality.Methods. Risk factors were assessed using a multicenter case-control-control study. Influence of ESBL production on mortality was studied in all patients with COBSI due to E. coli. Isolates and ESBLs were microbiologically characterized. Statistical analysis was performed using multivariate logistic regression. Thirteen tertiary care Spanish hospitals participated in the study.Results. We included 95 case patients with COBSI due to ESBLEC, which accounted for 7.3% of all COBSI due to E. coli. The ESBL in 83 of these (87%) belonged to the CTX-M family of ESBL, and most were clonally unrelated. Comparison with both control groups disclosed association with health care (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.8), urinary catheter use (OR, 3.1; 95% CI, 1.5-6.5), and previous antimicrobial use (OR, 2.7; 95% CI, 1.5-4.9) as independent risk factors for COBSI due to ESBLEC. Mortality among patients with COBSI due to ESBLEC was lower among patients who received empirical therapy with beta-lactam/beta-lactam inhibitor combinations or carbapenems (8%-12%) than among those receiving cephalosporins or fluoroquinolones (24% and 29%, respectively). Mortality among patients with COBSI due to E. coli was associated with inappropriate empirical therapy irrespective of ESBL production.Conclusions. ESBLEC is an important cause of COBSI due to E. coli. Clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.