Predictors of mortality among patients with community-onset infection due to extended-spectrum beta-lactamase-producing Escherichia coli in Thailand .

A matched case-control study was performed to identify predictors of mortality among patients (n = 46) with community-onset infections due to extended-spectrum beta-lactamase-producing Escherichia coli in Thailand. The crude mortality rate was 30%. By multivariable analysis, community-onset bloodstream infection due to extended-spectrum beta-lactamase-producing E. coli was the sole predictor of mortality (adjusted odds ratio, 41.3 [95% confidence interval, 4.3-69.4]; [P= .001).     

Genetic background of Escherichia coli and extended-spectrum beta-lactamase type

To assess the implication of the genetic background of Escherichia coli strains in the emergence of extended-spectrum-Beta -lactamases (ESBL), 55 TEM-, 52 CTX-M-, and 22 SHV-type ESBL-producing clinical isolates involved in various extraintestinal infections or colonization were studied in terms of phylogenetic group, virulence factor (VF) content (pap, sfa/foc, hly, and aer genes), and fluoroquinolone resistance. A factorial analysis of correspondence showed that SHV type, and to a lesser extent TEM type, were preferentially observed in B2 phylogenetic group strains that exhibited numerous VFs but were fluoroquinolone-susceptible, whereas the newly emerged CTX-M type was associated with the D phylogenetic group strains that lacked VF but were fluoroquinolone-resistant. Thus, the emergence of ESBL-producing E. coli seems to be the result of complex interactions between the type of ESBL, genetic background of the strain, and selective pressures in ecologic niches.     

大肠埃希菌产超广谱β-内酰胺酶的危险因素研究

目的探索大肠埃希菌(E.coli)产超广谱β-内酰胺酶(ESBLs)的危险因素,为制定预防控制策略提供科学依据。方法采用抑制剂增强双纸片扩散法检测ESBLs,以桂林某医院微生物实验室首次分离产ESBLs E.coli的病例为病例组,非产ESBLs E.coli的病例为对照组,采用logistic回归分析进行研究。结果213例病例分离出E.coli ESBLs 111例,ESBLs总体阳性率为52.11%,外科阳性率为61.36%,高于内科45.60%。医院感染、住院时间≥7d、联用抗生素、三代头孢菌素、氟喹诺酮类抗菌药物和β-内酰胺酶抑制剂复合抗生素使用是E.coli产ESBLs的危险因素,其中住院时间≥7d、三代头孢菌素和联用抗生素是独立危险因素。结论住院病人E.coli的ESBLs阳性率高,产ESBLs危险因素复杂多样,应该采取综合措施来预防和控制产ESBLs菌株的流行。     

Dissemination of clonally related Escherichia coli strains expressing extended-spectrum beta-lactamase CTX-M-15

We analyzed 43 CTX-M-15-producing Escherichia coli isolates and 6 plasmids encoding the blaCTX-M-15 gene from Canada, India, Kuwait, France, Switzerland, Portugal, and Spain. Most isolates belonged to phylogroups B2 (50%) and D (25%). An EC-B2 strain of clonal complex sequence type (ST) 131 was detected in all countries; other B2 isolates corresponded to ST28, ST405, ST354, and ST695 from specific areas. EC-D strains were clonally unrelated but isolates from 3 countries belonged to ST405. All CTX-M-15 plasmids corresponded to IncFII group with overrepresentation of 3 HpaI-digested plasmid DNA profiles (A, B and C; 85-120kb, similarity > or =70%). Plasmid A was detected in EC-B2 strains (ST131, ST354, or ST405), plasmid C was detected in B2 and D strains, and plasmid B was confined to worldwide-disseminated ST131. Most plasmids contained blaOXA-1, aac(6')-Ib-cr, and blaTEM-1. Worldwide dissemination of CTX-M-15 seems to be determined by clonal complexes ST131 and ST405 and multidrug-resistant IncFII plasmids.     

Escherichia coli producing CTX-M-2 beta-lactamase in cattle, Japan

From November 2000 to June 2001, Escherichia coli strains producing CTX-M-2 beta-lactamase were isolated from 6 (1.5%) of 396 cattle fecal samples and 2 (0.7%) of 270 surface swabs of cattle carcasses in Japan. The blaCTX-M-2 gene responsible for CTX-M-2 production was encoded on transferable plasmids, and the gene was transferred to E. coli CSH2 with a very high frequency (2 x 10(-4) to 6 x 10(-1) per donor cells) by conjugation. Random amplified polymorphic DNA analysis of nine isolates showed at least five different patterns. These findings suggest that CTX-M-2 producers might have originated from cattle through the use of cephalosporins such as ceftiofur and that cattle could be a reservoir of CTX-M-2-producing E. coli. Continuous and strategic surveillance of antimicrobial-resistant bacteria in livestock is essential to suppress further dissemination of these bacteria into society at large.     

Approaches to characterize extended spectrum beta-lactamase/beta-lactamase producing Escherichia coli in healthy organized vis-a-vis backyard farmed pigs in India

The study was undertaken to investigate the occurrence and to characterize the ESBL/beta-lactamase producing-Escherichia coli in healthy pigs of organized and backyard farms in West Bengal, India. Total 200 rectal swabs were collected randomly from healthy pigs maintained in four organized farms and 10 backyard farms (n = 100 each) and 76 isolates were identified as E. coli from organized (48/100, 48%) and backyard pigs (28/100, 28%). Twelve E. coli isolates (6%) in the present study were detected to possess any of the ESBL/beta-lactamase genes studied. ESBL/beta-lactamase producers were isolated with significantly more frequency from backyard pigs than the organized farm pigs (p = 0.026). Six of ESBL/beta-lactamase producing isolates were phenotypically confirmed as CTX-M producers and ten of them were confirmed as TEM/SHV producers. PCR and sequencing of the amplified product from representative isolates revealed the presence of bla_CTX-M-9, bla_SHV-12 and bla_TEM-1. No unique combination of the studied beta lactamase genes for organized and backyard farm pig isolates was noted. The ESBL isolates belonged to O13, O55, O133, O153, O157, O158, O166, rough and OUT serogroups. The association of heat labile toxin (elt) (p < 0.0005) with organized farm isolates and heat stable toxin (estA) (p = 0.0143) with backyard piggery sector was significantly higher. The ESBL/beta-lactamase producers from organized farm (Ak/Ex) and indigenous pigs (Ak/Ex/Te; Ak/CoT/G) showed a characteristic phenotypical antibiotic resistance pattern. Two pairs of isolates from organized and backyard farm pigs showed clonal relationship indicating a possible transmission between the farms which were situated adjacently. Thus the present study revealed backyard farm pigs as major source of ESBL/beta-lactamase producing-E. coli associated with STa and characteristic antibiotic resistance pattern in India.     

临床分离大肠埃希菌耐药性及产超广谱β-内酰胺酶株危险因素分析

目的 分析临床分离大肠埃希菌(Escherichia coli,E.coli)的耐药性及产超广谱β-内酰胺酶株感染危险因素.方法 回顾性分析2011年临床分离的825株E.coli的耐药性,比较产ESBLS和不产ESBLS大肠埃希菌的耐药性;以不产ESBLS大肠埃希菌为对照菌株,对产ESBLS肠埃希菌感染危险因素进行分析.结果 825株E.coli中检出产ES-BLs菌565株,检出率为68.5％.分离的E.coli均对亚胺培南和美洛培南敏感,产ESBLs菌株对阿莫西林/克拉维酸、头孢哌酮-舒巴坦以及阿米卡星、头孢西丁的耐药率较低.18个与产ESBLS感染可能相关的危险因素中,4个为独立危险因素,即ICU住院时间＞7 d(OR=2.708,95％C.I 1.701～4.312)、机械通气及导尿(OR=2.671,95％C.I 1.747～4.084)、三代头孢菌素类抗菌药物使用(OR=6.790,95％C.I 4.126～11.173)和COPD(OR=9.302,95％C.I 2.227～38.857).产ESBLS株感染或定植患者死亡率高于非产ESBLS大肠埃希菌(P＜0.05).结论 临床分离的大肠埃希菌中产ESBLS株的检出率高、耐药性强,其感染或定植所致死亡率高.产ESBLS株感染与多个危险因素密切相关,加强对这些危险因素的控制有助于预防产ESBLS株感染的扩散.     

Risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae in Thailand.

A matched case-control study was performed to evaluate the risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in Thailand. By multivariable analysis, prior exposure to third-generation cephalosporins and transfer from another hospital were risk factors associated with infection. Receipt of inadequate antimicrobial therapy was a predictor of mortality.     

A nosocomial outbreak of Escherichia coli producing CTX-M-15 and OXA-30 beta-lactamase.

During a survey of the prevalent subtypes of extended-spectrum beta -lactamases in a university hospital in Korea, a nosocomial outbreak of Escherichia coli producing CTX-M-15 and OXA-30 beta -lactamases was detected. The outbreak comprised various infections, including bloodstream infections and colonization, and persisted for several months in various areas of the hospital.     

结核病死亡率影响因素研究现状

在世界范围内结核病曾经是导致人口死亡的首要病因,1880年结核病在北美土著人中暴发,死亡率高达9000/10万,到了1912年,美洲的黑奴中结核病的死亡率达到700/10万[1].     

Emergence of Escherichia coli isolates producing conjugative plasmid-mediated DHA-1 beta-lactamase in a Korean university hospital

Seven isolates of cefoxitin-resistant Escherichia coli with an inducible phenotype were detected between November 2002 and July 2003 in a Korean hospital. Conjugations were tested by the filter mating method using azide-resistant E. coli J53 as the recipient. All isolates and their transconjugants were tested for broth microdilution minimum inhibitory concentrations, isoelectric focusing (IEF), polymerase chain reaction (PCR) for SHV, TEM, CTX-M and DHA-derived beta-lactamases, and DNA sequencing. XbaI-digested genomic DNA bands of the seven isolates were separated by pulsed-field gel electrophoresis (PFGE). IEF, PCR and sequence analysis revealed that all isolates possessed a blaTEM-1-like and a blaDHA-1 gene. Two isolates also carried the blaCTX-M-14 gene. Transfer of the resistance by conjugation experiments of all seven isolates was successful, suggesting that the blaDHA-1-containing plasmids in the E. coli isolates were self-transmissible. The isolates were recovered from patients in wards or an intensive care unit, all of which had been exposed to beta-lactams before isolation of the DHA-1 producers. Five patterns among the seven isolates were demonstrated by PFGE; sporadic infections with E. coli possessing an inducible beta-lactam resistance phenotype were found. DHA-1 encoded by conjugative plasmids conferred the resistance phenotype. The spread of the DHA-1 producers was due to both clonal spread and horizontal transfer of the resistance gene.     

产超广谱β-内酰胺酶大肠埃希菌β-内酰胺酶基因研究

目的检测20株产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的β-内酰胺酶基因,以便了解该20株产ESBLs大肠埃希菌β-内酰胺酶基因亚型携带存在状况。方法收集医院2013年分离到的20株产ESBLs大肠埃希菌,采用聚合酶链反应(PCR)方法分析16种A类β-内酰胺酶基因、6种C类β-内酰胺酶基因、3种D类β-内酰胺酶基因。结果 20株产ESBLs大肠埃希菌对头孢呋辛、头孢噻肟、头孢吡肟的耐药率均为100.0%;共检出4种A类β-内酰胺酶基因,其中检出blaTEM16株、blaSHV1株、blaCTX-M-1 cluster 3株、blaCTX-M-9 cluster 14株,检出率分别为80.0%、5.0%、15.0%、70.0%,C类β-内酰胺酶基因检出blaDHA2株,检出率为10.0%,D类β-内酰胺酶基因检出blaOXA-1 cluster 3株,检出率为15.0%;20株产ESBLs大肠埃希菌每一株均有β-内酰胺酶基因检出,少者检出1种,多者同时检出2⁴种,且该组菌株blaCTX-M总检出率85.0%。结论产β-内酰胺酶基因是该组大肠埃希菌对β-酰胺类抗菌药物产生耐药的重要原因。     

大肠埃希菌产超广谱β-内酰胺酶危险因素病例对照研究

目的 探讨大肠埃希菌产超广谱β-内酰胺酶（ESBLs）的危险因素。方法 以2005年7月2006年8月某院微生物实验室分离出产ESBLs大肠埃希菌的病例111例为病例组，同期分离出非产ESBLs大肠埃希菌的病例102例为对照组，分别采用单因素和多因素Logistic回归分析危险因素。结果医院感染、住院时间≥7d、联合使用抗菌药物及第三代头孢菌素、氟喹诺酮类抗菌药物和β-内酰胺酶抑制剂复合抗生素的使用是大肠埃希菌产ESBLs的危险因素，其中住院时间≥7d、使用第三代头孢菌素和联合使用抗菌药物是独立危险因素。除亚胺培南、阿米卡星和头孢西丁外，产ESBLs菌株对其他13种抗菌药物的耐药率均高于非产ESBLs菌株（P〈0．005～0．025）。结论 产ESBLs菌株耐药率高；遏制细菌产ESBLs及其传播，须合理选用抗菌药物，尽量缩短住院时间，并采取综合措施监控医院感染。     

A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants

To determine the risk factors for rectal colonization by extended-spectrum beta-lactamase (ESBL) Klebsiella sp. in 368 newborns admitted consecutively to a neonatal intensive care unit over six months, rectal swabs were cultured on admission and weekly until discharge. Eighty infants (21.7%) had ESBL Klebsiella sp. cultured from their rectal swabs. Eighty controls were selected at random from infants with negative cultures admitted within the 14-day period prior to the detection of ESBL Klebsiella sp. in the cases. Cases had significantly lower birth weight, gestational age, earlier age of admission, longer hospital stay, and higher proportions of congenital malformations, early-onset pneumonia and respiratory distress syndrome compared with controls. Significantly more cases received mechanical ventilation, nasal continuous positive airway pressure support, total parenteral nutrition, umbilical vascular catheterization, arterial line insertion, urinary bladder catheterization, and prior treatment with antibiotics. However, stepwise logistic regression analysis showed that only two independent risk factors were significantly associated with ESBL rectal colonization: duration of hospital stay [adjusted odds ratio (OR): 1.3; 95% confidence intervals (CI): 1.2, 1.4; P<0.0001) and early-onset pneumonia (adjusted OR: 8.3; 95% CI: 1.6, 43.4; P=0.01).     

鸡来源产超广谱β-内酰胺酶大肠埃希菌携带整合子基因的研究

目的 分析鸡肠道内共生的产超广谱β-内酰胺酶(ESBLs)大肠埃希菌整合子携带状况以及其与多重耐药性的关系.方法 从甘肃、湖北、北京、四川地区养殖场鸡粪便标本中分离的大肠埃希菌,肉汤稀释法检测菌株的耐药性,WHONET软件进行耐药性分析;筛选出的ESBLs菌株进行整合子的PCR检测和基因测序. 结果 通过药敏试验从鸡粪中分离的224株大肠埃希菌中共检出产ESBLs的菌株54株,分离率为24.1%.产ESBLs的菌株中I类整合子的携带率为63.0%,I类整合子可变区发现的耐药基因有addA1、aadA2、aadA5、aadA22,dfrA12、dfrA17、dfrI,aar-3,分别介导氨基糖苷类、磺胺类抗生素以及利福平的耐药性.aadA22是在国内菌株中首次报道.Ⅱ类整合子携带率为5.6%,携带的耐药基因包括sat、ereA、aadA1.Ⅲ类整合子酶阳性的有3株菌,但其可变区未检出任何耐药基因. 结论 I类整合子主要介导氨基精苷类抗生素和甲氧嘧啶的耐药性,在大肠埃希菌ESBLs菌株的多重耐药性中具有重要的作用,加强养殖动物大肠埃希菌耐药性以及整合子携带状况的监测,对防止耐药菌株的广泛传播,改善临床抗生素的疗效具有重要意义.     

Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak.

During 11 months 58 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) isolates were grown from 10 patients on a neurological early rehabilitation unit. The patients had no signs of infection but were colonized in the nose and trachea, and unusually only one had colonization in the gut. A single clone of ESBL-Kp was identified by pulse field gel electrophoresis. Strong hygienic precautions similar to those for Methicillin-resistant Staphylococcus aureus patients prevented spread of the bacteria to other wards. However, rehabilitation for patients with severe neurological failures made it very difficult to follow hygienic requirements. Disinfection of mucous membranes was difficult. Eventually the application of a nasal spray containing povidone-iodine proved to be successful.     

住院患者产CTX-M型ESBLs和KPC的大肠埃希菌感染分布与耐药基因分析

目的了解住院患者产CTX M型超广谱β 内酰胺酶（ESBLs）和碳青霉烯酶（KPC）大肠埃希菌感染的临床分布与耐药情况。方法收集某院2011-2012年临床送检标本分离的多重耐药大肠埃希菌,采用微量肉汤稀释法检测抗菌药物最低抑菌浓度（MIC）;聚合酶链反应（PCR）扩增ESBLs和KPC基因,确定CTX M和KPC基因型别及MLST分型。结果48株多重耐药大肠埃希菌中单产ESBLs 45株（93.75%）,携带blaCTX M基因者44株（91.67%）,其中blaCTX M 1组基因20株（41.67%）、blaCTX M 9组基因32株（66.67%）,同时携带两组基因者8株（16.67%）。经基因测序确定的基因亚型有CTX M 14（65.91%,29/44）、CTX M 55（31.82%,14/44）、CTX M 15（11.36%,5/44）、CTX M 3（2.27%,1/44）、CTX M 24（2.27%,1/44）和CTX M 65（2.27%,1/44）,其中CTX M 14+CTX M 55（11.36%,5/44）、CTX M 14+CTX M 15（4.55%,2/44）和CTX M 55+CTX M 65（2.27%,1/44）。产ESBLs+KPC菌株中2株（4.17%）经PCR扩增均携带blaKPC和 blaCTX M基因,经测序分析1株为CTX M 14+KPC 2,1株为CTX M 3+KPC 2。ST131 （53.66%）是主要的MLST型别,检测到ST648、ST405、ST167、ST1193等ST型。 结论该院大肠埃希菌产ESBLs基因型中CTX M 14、CTX M 55和CTX M 15亚型最常见,存在多种不同亚型;ST131是主要的MLST型别,检测到产KPC 2型碳青霉烯酶菌。     

Wide dissemination of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp. in acute care and rehabilitation hospitals

A prospective surveillance system for extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) and ESBL-producing Klebsiella spp. (ESBL-K) was implemented in 39 German hospitals with the aim of determining the incidence densities (IDs) of community-onset and hospital-onset cases and of identifying risk factors for high IDs of hospital-onset cases. During 2008, 2081 ESBL-E/K cases were documented. ESBL-E cases (n=1330, 63·9%) were more common than ESBL-K cases (n=751, 36·1%), but a higher proportion of ESBL-K cases (59%) than of ESBL-E cases (39·5%) were hospital-onset cases. The mean IDs were 0·54 (range 0-2·53) per 1000 patient-days for all ESBL-EK cases, 0·29 (range 0-1·81) per 1000 patient-days for community-onset ESBL-EK cases and 0·25 (range 0-1·82) per 1000 patient-days for hospital-onset ESBL-EK cases. Regression analysis showed a linear association between the IDs of community-onset and hospital-onset cases. The wide dissemination of ESBL-E and ESBL-K emphasizes the need for hospital-wide surveillance to guide control measures.     

2018年中国因跌倒/坠落就诊患者损伤严重程度及影响因素

目的  了解中国因跌倒/坠落就诊病例流行特征和影响损伤严重程度的因素,为制定跌倒/坠落防控措施、政策提供依据。 方法  通过提取2018年中国伤害监测系统（national injury surveillance system,NISS）中跌倒/坠落病例数据,描述其流行特征,采用多因素Logistic回归分析模型分析损伤严重程度影响因素。 结果  共收集跌倒/坠落病例500 621例。损伤严重程度以轻度为主（76.00%）,中、重度损伤所占比例为24.00%。单因素分析显示,性别、年龄、城乡、发生季节、发生时段、发生地点、发生时活动、发生前饮酒情况的跌倒/坠落病例损伤严重程度差异具有统计学意义（均有P＜0.001）。多因素分析显示,男性（OR=1.056,95% CI：1.041~1.071）;年龄为5~岁（OR=1.412,95% CI：1.366~1.460）、15~岁（OR=1.382,95% CI：1.337~1.427）、30~岁（OR=1.844,95% CI：1.787~1.903）、45~岁（OR=2.746,95% CI：2.666~2.829）、≥65岁（OR=4.524,95% CI：4.390~4.663）;夏季（OR=1.097,95% CI：1.077~1.118）、秋季（OR=1.110,95% CI：1.089~1.131）、冬季（OR=1.137,95% CI：1.116~1.159）;地点为家中（OR=1.169,95% CI：1.143~1.196）、学校与公共场所（OR=1.102,95% CI：1.069~1.136）、体育和运动场所（OR=1.066,95% CI：1.016~1.119）、工业和建筑场所（OR=1.800,95% CI：1.727~1.877）、农场/农田（OR=1.257,95% CI：1.196~1.320）;活动为步行（OR=1.084,95% CI：1.045~1.126）;发生前饮酒（OR=1.318,95% CI：1.257~1.381）是中重度损伤的危险因素。 结论  中国因跌倒/坠落就诊患者中重度损伤占一定比例,且影响因素较多,相关部门应开展针对性的防控工作。