Risk factors of urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli in emergency department

Objectives

The incidence of urinary tract infection (UTI) due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has increased over recent years. Initial empirical therapy is often ineffective for these resistant isolates resulting in prolonged hospitalization and increased mortality. This study was conducted to determine the risk factors of UTI caused by ESBL E. coli in the emergency department (ED).

儿童各类标本中产超广谱β-内酰胺酶菌危险因素研究

目的 研究儿童各类标本中产超广谱β-内酰胺酶菌(ESBLs)的危险因素,为临床预防与控制产ESBLs菌株的传播和流行提供参考依据.方法 随机抽取山西省儿童医院2007年1月-2009年4月各类标本中ESBLs阳性和阴性病例各100份进行病例对照研究.结果 单因素分析结果显示,男性、年龄<1岁、有既往病史、内科、肺炎、医院感染、入院前使用抗菌药物均是ESBLs的危险因素;入院时白细胞数偏高和中性粒细胞百分比偏高是ESBLs的保护因素;ESBLs与手术、输血及其他侵入性操作的相关性未见统计学意义;多因素非条件Logistic回归显示男性、有既往病史、医院感染、入院前使用抗菌药物、内科是产ESBLs的危险因素,有肛管是保护因素.结论 提高对具有相关危险因素患儿的细菌学送检率,对预防与控制ESBLs细菌的传播和流行有重要意义.     

肺炎克雷伯菌超广谱β-内酰胺酶表型及β-内酰胺酶基因型检测

目的 了解临床分离的肺炎克雷伯菌(KPN)产超广谱β-内酰胺酶(ESBIs)及β-内酰胺酶(BLA)基因型存在状况.方法 在2005年9月-2006年4月从住院患者中分离25株KPN,采用美国CLSI推荐的表型确证试验方法检测ESBLs,用PCR及序列分析的方法分析21种(群、簇)BLA基因bla_(TEM)、bla_(SHV)、bla_(LEN)、bla_(OKP)、bla_(CTX-M-1)群、bla_(CTX-M-2)群、bla(CTX_M_9)群、bla_(OXA-1)群、bla_(OXA-2)群、bla_(CARB)、bla_(PER)、bla_(VEB)、bla_(GES)、bla_(LAP)、bla_(DHA)、bla_(ACT/MIR)、bla_(CMY/MOX)、bla_(FOX)、bla_(CMY/LAT)、bla_(ACC).结果 25株KPN中,ESBLs阳性14株(56.0%)、阴性5株(20.0%)、"不确定"6株(24.0%);bla_(TEM)、bla_(SHV)、bla_(CTX-M-1)群、bla_(OXA-10)群、bla_(LAP)和bla_(DHA)基因阳性株数(%)分别为20株(80.0%)、1株(4.0%)、1株(4.0%)、20株(80.0%)、1株(4.0%)、8株(32.0%),而其余15种(群、簇)基因均阴性;21种(群、簇)BLA基因总阳性率为92.0%;其中HZ12593号菌株bla_(LAP-2)基因序列已登录GenBank,注册号为EU529981.结论 临床分离的KPN产ESBIs比例较高,至少存在6种BLA基因,BLA基因型以bla_(TEM)和bla_(OXA-10)群为主,KPN携带bla_(DHA)基因可以影响ESBLs表型确证试验结果.     

产超广谱β-内酰胺酶腹泻病原菌的耐药分析

目的 了解腹泻病原菌产超广谱β-内酰胺酶的情况,分析产超广谱β-内酰胺酶细菌的耐药性。方法 对分离的腹泻病原菌采用标准纸片扩散法检测超广谱β-内酰胺酶,K—B法检测其耐药性。结果461株分离的腹泻病原菌中有96株产超广谱β-内酰胺酶检出率为12．6％;阳性菌不仅对头孢类抗生素耐药性高,对其他抗生素也有较高的耐药性,但对美洛培南敏感。结论 腹泻病原菌中超广谱β-内酰胺酶检出率较高,阳性菌呈现多重耐药性。     

SHV-28, AN EXTENDED-SPECTRUM β-LACTAMASE PRODUCED BY A CLINICAL ISOLATE OF KLEBSIELLA PNEUMONIAE IN SOUTH INDIA

SHV-28, an extended spectrum β-lactamase from a clinical isolate of Klebsiella pneumoniae, had an isoelectric point of 7.6 and a substrate profile showing preferential hydrolysis for cefotaxime over ceftazidime. It differed from SHV-1 by one amino acid substitution. The conserved S–T–F–K and K–T–G motifs were identified by SHV-28 protein sequencing.     

Observation on integron carriage among clinical isolates of Klebsiella pneumoniae producing extended-spectrum β-lactamases

Purpose: Klebsiella pneumoniae is considered an important pathogen causing nosocomial and community-acquired infections and is often associated with the production of extended-spectrum β-lactamases (ESBL) belonging to SHV and CTX-M families, which are frequently described as a part of complex integrons, facilitate their horizontal transfer to other related as well as unrelated microbes. The present study was undertaken to investigate the occurrence and characterization of integrons among K pneumoniae isolates producing ESBL in a tertiary referral hospital. Materials and Methods: A total of 136 clinical isolates of K pneumoniae were investigated for the presence of ESBL. Their ESBL genes were characterized by multiplex polymerase chain reaction (PCR). Integrase gene PCR was performed to detect the presence of integron. The isolates were further typed by random amplification of polymorphic DNA (RAPD). Result: Out of 136 K pneumoniae isolates, 63 (46%) were confirmed to be ESBL producers. SHV (68%) and CTX–M (67%) ESBL genes were the most common in our study. Of the 63 ESBL-positive isolates, 58 (92%) strains carried integrons; 52 strains (82%) carried only class 1 integron, whereas 6 (9%) isolates harboured both class 2 integrons and the class 1 gene. However, in ESBL negatives, only 29 (40%) strains were positive for class 1 integron and none for class 2 integron. Conclusion: The presence of class 2 integron amongst ESBL-producing K pneumoniae is being described for the first time in this part of the world. The findings of this study strongly suggest that integrons have a role in the dissemination of ESBL-mediated resistance among the nosocomial isolates of K pneumonia.     

肺炎克雷伯菌产超广谱β-内酰胺酶基因分型研究

目的调查广州地区下呼吸道感染肺炎克雷伯菌产超广谱β-内酰胺酶(ESBL)的分离率及各种基因型的流行病学分布。方法收集广州地区13家医院2001-10～2002-12临床分离的肺炎克雷伯菌511株,采用美国临床实验室标准化委员会规定的ESBL表型筛选和确证试验确定ESBL的发生率、PCR扩增对产ESBL菌初步分型,然后对部分PCR扩增阳性产物测序,序列分析进一步确定基因型。结果肺炎克雷伯菌产ESBL分离率为40.1%。TEM型49株占21.9%,均为TEM-1型;CTX-M型59株占28.8%;SHV型96株占46.8%。结论SHV型是广州地区下呼吸道感染肺炎克雷伯菌产ESBL流行的常见基因型。     

A 5-day course of oral antibiotics followed by faecal transplantation to eradicate carriage of multidrug-resistant Enterobacteriaceae: a randomized clinical trial

ObjectivesIntestinal carriage with extended spectrum β-lactamase Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) can persist for months. We aimed to evaluate whether oral antibiotics followed by faecal microbiota transplantation (FMT) can eradicate intestinal carriage with ESBL-E/CPE.MethodsRandomized, open-label, superiority trial in four tertiary-care centres (Geneva (G), Paris (P), Utrecht (U), Tel Aviv (T)). Non-immunocompromised adult patients were randomized 1: 1 to either no intervention (control) or a 5-day course of oral antibiotics (colistin sulphate 2 × 10⁶ IU 4×/day; neomycin sulphate 500 mg 4×/day) followed by frozen FMT obtained from unrelated healthy donors. The primary outcome was detectable intestinal carriage of ESBL-E/CPE by stool culture 35–48 days after randomization (V4). ClinicalTrials.gov NCT02472600. The trial was funded by the European Commission (FP7).ResultsThirty-nine patients (G = 14; P = 16; U = 7; T = 2) colonized by ESBL-E (n = 36) and/or CPE (n = 11) were enrolled between February 2016 and June 2017. In the intention-to-treat analysis 9/22 (41%) patients assigned to the intervention arm were negative for ESBL-E/CPE at V4 (1/22 not receiving the intervention imputed as positive) whereas in the control arm 5/17 (29%) patients were negative (one lost to follow up imputed as negative) resulting in an OR for decolonization success of 1.7 (95% CI 0.4–6.4). Study drugs were well tolerated overall but three patients in the intervention group prematurely stopped the study antibiotics because of diarrhoea (all received FMT).ConclusionsNon-absorbable antibiotics followed by FMT slightly decreased ESBL-E/CPE carriage compared with controls; this difference was not statistically significant, potentially due to early trial termination. Further clinical investigations seem warranted.     

新生儿感染产超广谱β—内酰胺酶肺炎克雷伯菌和大肠埃希菌药敏分析

目的：探讨新生儿病房产超广谱β－内酰胺酶（ESBLs)肺炎克雷伯菌和大肠埃希菌耐药特点,指导临床用药。方法：经痰、血、脑脊液培养确诊为产ESBLs肺炎克雷伯菌及大肠埃希菌引起新生儿感染69例,分析药敏试验结果及治疗情况。结果：产ESBLs菌对亚胺培南普遍敏感,对舒普深耐药率低,肺炎克雷伯菌耐药率为36．36％,大肠埃希菌为25．0％,对头孢他啶、头孢曲松、头孢噻肟及氨曲南耐药率高达75％－100％,且部分体外敏感菌株在体内却表现出临床意义的耐药,对磺胺类．氨基糖甙类．氟喹诺酮类均表现出较高的耐药性。结论：亚胺培南及含β－内酰胺酶抑制剂复合物为新生儿病房产ESBLs菌感染的首选药物。