产ESBLs大肠检出情况有奖调查

细菌耐药

最近，《医院感染预防与控制最佳实践丛书》正在紧张地进行中。根据专家审稿意见，《多重耐药》分册需要补充多重耐药菌在各个地区或国家所占的百分比的最新资料。因此，需要查阅大量文献，特开此贴，有奖征集相关的文献。

本贴调查产ESBLs大肠埃希菌占大肠埃希菌的比例，共需要收集美国、英国、日本、印度和中国的数据。

文献要求：以大型监测数据或多中心流调为主，尽量查阅最新的数据，目前应该以2009年或2010年的数据为主，2011年的数据肯定还没有发表成文。将文献题目、摘要、发表期刊、年份及相关的“产ESBLs大肠埃希菌占大肠埃希菌的比例”的数据以回贴的形式发出。

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细菌耐药

Vet Rec. 2011 Dec 17;169(25):656. Epub 2011 Oct 21.
Investigation of the presence of ESBL-producing Escherichia coli in the North Wales and West Midlands areas of the UK in 2007 to 2008 using scanning surveillance.
Snow LC, Wearing H, Stephenson B, Teale CJ, Coldham NG.
SourceAnimal Health Veterinary Laboratories Agency (AHVLA) - Centre for Epidemiology and Risk Analysis, New Haw, Addlestone, Surrey, KT15 3NB, UK.

Abstract
Between November 5, 2007 and November 4, 2008, faecal samples from cattle and sheep submitted for diagnostic purposes to the Aberystwyth and Shrewsbury Veterinary Laboratories Agency (VLA) (now AHVLA) regional laboratories (covering North Wales and the West Midlands) were screened for the presence of Escherichia coli that produces CTX-M extended-spectrum β-lactamase (ESBL) using the selective medium CHROMagar CTX. Samples from 113 farms were tested and eight ESBL-positive farms identified. Of these, six farms were identified via submissions of cattle faeces and two from sheep. Gene sequencing revealed both group 1 and group 9 CTX-M enzymes corresponding to CTX-M-14, CTX-M-14B (group 9) and CTX-M-15/28 (group 1). Analysis of these isolates by nanoarray revealed that some were carrying a range of virulence genes including ireA, iroN and prfB, which have been associated with extraintestinal pathogenic E coli, and were multidrug resistant. Geographical analysis with choropleth maps suggested that these CTX-M genes are relatively widespread in the North Wales and West Midlands study area. This work was carried out concurrently with the running of a VLA ESBL surveillance system, which has subsequently identified many more CTX-M positive farms in the UK.

PMID:22021063[PubMed - indexed for MEDLINE]

细菌耐药

J Antimicrob Chemother. 2011 Sep;66(9):2126-35. Epub 2011 Jun 21.
Impact of a clonal outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK.
Webster DP, Young BC, Morton R, Collyer D, Batchelor B, Turton JF, Maharjan S, Livermore DM, Bejon P, Cookson BD, Bowler IC.
SourceBrighton and Sussex Medical School, Falmer, UK. d.webster@bsms.ac.uk

Abstract
OBJECTIVES: The objectives of this study were: (i) to describe an outbreak of multidrug-resistant Klebsiella pneumoniae in our population; (ii) to identify the potential source of this outbreak by examining antibiotic resistance trends in urocultures; (iii) to evaluate the contribution of this outbreak to resistance patterns over time in the two commonest Gram-negative blood culture isolates, namely K. pneumoniae and Escherichia coli; and (iv) to assess risk factors for multidrug resistance and the impact of this resistance on mortality and length of stay.

METHODS: We searched Microbiology and Patient Administration Service databases retrospectively and describe resistance trends in E. coli and K. pneumoniae bloodstream infections (BSIs) in Oxfordshire, UK, over an 11 year period.

RESULTS: An outbreak of a multidrug-resistant, CTX-M-15 extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae clone was identified and shown by multilocus sequence typing to belong to a novel sequence type designated ST490. This was associated with a sporadic change in resistance rates in K. pneumoniae BSIs with rates of multidrug resistance (defined as resistance to three or more antibiotic classes) reaching 40%. A case-control study showed prior antibiotic exposure as a risk factor for infection with this organism. During the same time period, rates of ESBL-producing Klebsiella spp. isolated from urocultures increased from 0.5% to almost 6%. By contrast, the rate of multidrug resistance in E. coli rose more steadily from 0% in 2000 to 10% in 2010.

CONCLUSIONS: Changes in resistance rates may be associated with outbreaks of resistant clones in K. pneumoniae. Changing resistance patterns may affect important health economic issues such as length of stay.

PMID:21693458[PubMed - indexed for MEDLINE]