Surveillance and Resistance of Community-Onset Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumonia in Oral and Maxillofacial Surgery Site Infections.

IF 1.4 4区医学 Q4 INFECTIOUS DISEASES

Surgical infections Pub Date : 2024-04-01 DOI:10.1089/sur.2023.230

Chun He, Shuangshuang Wu, Xu Wang, Linman Li, Zhimin Yan

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引用次数: 0

Abstract

Background: The prevalence of community-onset infections of extended spectrum β-lactamase (ESBL)-producing strains has increased globally, yet surveillance and resistance in patients with oral and maxillofacial surgery site infections is less investigated. Patients and Methods: A retrospective cohort study was performed to investigate risk factors and resistance of ESBL-producing Escherichia coli (ESBL-EC) and ESBL-producing Klebsiella pneumonia (ESBL-KP) among community-onset patients with oral and maxillofacial surgery during January 2010 to December 2016. Demographic features, predisposing factors, clinical outcomes, and antibiotic agent costs were analyzed. Antimicrobial susceptibility testing of nine antimicrobial agents against ESBL-KP and ESBL-EC were measured. Results: Among 2,183 cultures from infection sites in patients with oral and maxillofacial surgery site (45 cases [2.06%]) were confirmed with community-onset ESBL-KP (24; 1.10%) or ESBL-EC (21; 0.96%) infection. Multivariable analysis showed the independent risk factors for ESBL-producing bacterial infection were prior history of hospitalization (adjusted odds ratio [aOR], 10.984; 95% confidence interval [CI], 5.965-59.879; p = 0.025) and malignant condition (aOR, 3.373; 95% CI 2.947-7.634; p = 0.024). Based on antimicrobial susceptibility testing, 57.8% ESBL-KP and ESBL-EC were found receiving inappropriate antimicrobial therapy, and antibiotic agent costs were higher than non-ESBL-producing bacterial infections ($493.8 ± $367.3 vs. $304.1 ± $334.7; p = 0.031). Conclusions: Infections caused by ESBL-KP and ESBL-EC among patients in sites with oral and maxillofacial surgery are associated with prior history of hospitalization and malignant conditions. Prompt detection and appropriate antibiotic administration for community-onset infections of ESBLs are necessary for such populations.

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口腔和颌面外科手术部位感染中社区发病的广谱 β-乳酰胺酶产生的大肠埃希菌和肺炎克雷伯菌的监测和耐药性。

背景：在全球范围内，产生广谱β-内酰胺酶（ESBL）的菌株在社区感染的发病率有所上升，但对口腔颌面外科手术部位感染患者的监测和耐药性研究较少。患者和方法：我们开展了一项回顾性队列研究，调查2010年1月至2016年12月期间社区发病的口腔颌面外科患者中产ESBL大肠埃希菌（ESBL-EC）和产ESBL克雷伯菌肺炎（ESBL-KP）的风险因素和耐药性。分析了人口统计学特征、诱发因素、临床结果和抗生素用药成本。对九种抗菌药物针对 ESBL-KP 和 ESBL-EC 的抗菌药物敏感性进行了测定。结果：在 2,183 例口腔颌面部手术患者感染部位的培养物中，有 45 例[2.06%]确认为社区发病的 ESBL-KP（24 例；1.10%）或 ESBL-EC（21 例；0.96%）感染。多变量分析显示，ESBL产气细菌感染的独立风险因素是既往住院史（调整后的几率比 [aOR]，10.984；95% 置信区间 [CI]，5.965-59.879；P = 0.025）和恶性疾病（aOR，3.373；95% CI，2.947-7.634；P = 0.024）。根据抗菌药物药敏试验，发现57.8%的ESBL-KP和ESBL-EC接受了不适当的抗菌药物治疗，抗菌药物费用高于非ESBL细菌感染（493.8美元±367.3美元 vs. 304.1美元±334.7美元；p = 0.031）。结论在口腔颌面外科手术部位的患者中，ESBL-KP 和 ESBL-EC 引起的感染与既往住院史和恶性疾病有关。对于这类人群，有必要及时发现社区感染的 ESBLs 并给予适当的抗生素治疗。

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来源期刊

Surgical infections INFECTIOUS DISEASES-SURGERY

CiteScore

3.80

自引率

5.00%

发文量

127

审稿时长

6-12 weeks

期刊介绍： Surgical Infections provides comprehensive and authoritative information on the biology, prevention, and management of post-operative infections. Original articles cover the latest advancements, new therapeutic management strategies, and translational research that is being applied to improve clinical outcomes and successfully treat post-operative infections. Surgical Infections coverage includes: -Peritonitis and intra-abdominal infections- Surgical site infections- Pneumonia and other nosocomial infections- Cellular and humoral immunity- Biology of the host response- Organ dysfunction syndromes- Antibiotic use- Resistant and opportunistic pathogens- Epidemiology and prevention- The operating room environment- Diagnostic studies