Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients
Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients
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DOI：
10.1128/jcm.42.3.1089-1094.2004
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发表时间：
2004-03-01
影响因子：
9.4
通讯作者：
Pascual, A
中科院分区：
文献类型：
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作者：
Rodríguez-Baño, J;Navarro, MD;Pascual, A
产超广谱β-内酰胺酶（ESBL）大肠埃希菌（ESBLEC）引起的非住院患者感染似乎正在不同国家出现。其发病率，流行病学和临床影响在社区还没有被研究。我们描述了西班牙非住院患者ESBLEC引起的感染的流行病学和临床特征，以及一项病例对照研究的结果，该研究旨在调查与获得这些生物体相关的风险因素。通过重复的基因外回文序列PCR评估生物体的克隆相关性。ESBLs和编码ESBLs的基因最初分别通过等电聚焦和PCR进行表征。纳入49例患者（76%尿路感染，22%无症状菌尿，2%急性胆管炎）。6例患者为菌血症。糖尿病（比值比，5.5; 95%置信区间，1.6 - 18.7），既往使用氟喹诺酮类药物（比值比，7.6; 95%置信区间，1.9至30.1），复发性尿路感染（比值比，4.5; 95%置信区间，1.3至15.1），既往住院（比值比，18.2; 95%置信区间，5.3至61.1），男性患者年龄较大（每年的比值比，1.03; 95%可信区间，1.03 ~ 1.05）被多变量分析确定为危险因素。ESBLEC分离株无克隆相关性。CTX-M-9组、SHV组和TEM组ESBLs的检出率分别为64%、18%和18%。ESBLEC是非住院患者尿路感染的紧急原因。没有证据表明ESBLEC菌株存在水平传播。应尽可能避免在高危患者中使用氟喹诺酮类药物，以避免选择这些微生物。
Infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) in nonhospitalized patients seem to be emerging in different countries. Their incidence, epidemiology, and clinical impact in the community have not been studied. We describe the epidemiology and clinical features of infections caused by ESBLEC in nonhospitalized patients in Spain and the results of a case-control study performed to investigate the risk factors associated with the acquisition of these organisms. The clonal relatedness of the organisms was assessed by repetitive extragenic palindromic sequence PCR. The ESBLs and the genes encoding the ESBLs were initially characterized by isoelectric focusing and PCR, respectively. Forty-nine patients (76% with urinary tract infections, 22% with asymptomatic bacteriuria, and 2% with acute cholangitis) were included. Six patients were bacteremic. Diabetes mellitus (odds ratio, 5.5; 95% confidence interval, 1.6 to 18.7), previous fluoroquinolone use (odds ratio, 7.6; 95% confidence interval, 1.9 to 30.1), recurrent urinary tract infections (odds ratio, 4.5; 95% confidence interval, 1.3 to 15.1), a previous hospital admission (odds ratio, 18.2; 95% confidence interval, 5.3 to 61.1), and older age in male patients (odds ratio per year, 1.03; 95% confidence interval, 1.03 to 1.05) were identified as risk factors by multivariate analysis. The ESBLEC isolates were not clonally related. The ESBLs were characterized as members of the CTX-M-9 group, the SHV group, and the TEM group in 64, 18, and 18% of the isolates, respectively. ESBLEC is an emergent cause of urinary tract infections in nonhospitalized patients. There was no evidence of horizontal transmission of ESBLEC strains. Avoidance of fluoroquinolone use in high-risk patients should be considered whenever possible in order to avoid the selection of these organisms.