【正文】 Rectal carriage of ESBLproducing anisms on the General and Neurosurgical ICUs, Leeds General Infirmary, M’Zali et al, ECCMID 2022 01020304050607080On a d m i ssi o n * D u r i n g st a yES B L +ES B L *Ten (62%) of the 16 patients ESBL+ on admission had been in hospital 48h 社區(qū)人群糞便攜帶 產(chǎn) ESBLs菌株的危險因素 Turk J Med Sci 2022。43(3):240–248 尿路感染 社區(qū)獲得（ CA）產(chǎn) ESBLs大腸埃希菌 尿路感染－ 危險因素 Clin Microbiol Infect 2022。35:60612 Group1：社區(qū)產(chǎn) ESBLs菌株感染患者 Group2：社區(qū)非產(chǎn) ESBLs菌株感染患者 社區(qū)獲得性產(chǎn) ESBLs大腸埃希菌 菌血癥 －危險因素 J Microbiol Immunol Infect 2022。50(1):408. ?經(jīng)驗(yàn)性治療首先要覆蓋 : ?大腸埃希菌 ?肺炎克雷伯菌 ?關(guān)注是否產(chǎn) ESBLs 社區(qū)革蘭陰性菌感染 （包括敗血癥） 適當(dāng)?shù)慕?jīng)驗(yàn)性治療 appropriate empiric therapy ? 感染患者起病 24－ 48h之內(nèi)選擇適當(dāng)?shù)慕?jīng)驗(yàn)性治療（ appropriate empiric therapy）是影響預(yù)后的重要因素！ 社區(qū)獲得性 產(chǎn) ESBLs大腸埃希菌感染 －危險因素 ARCH INTERN MED/VOL 168 (NO. 17), SEP 22, 2022 ? 年齡 60歲以上 ? 女性 ? 糖尿病 ? 反復(fù)的尿路感染 ? 衛(wèi)生保健相關(guān)感染 ? 之前抗菌藥物的應(yīng)用 ? 特別的抗菌藥物：氨基青霉素、頭孢菌素、氟喹諾酮類 ? 侵襲性泌尿道操作 ARCH INTERN MED/VOL 168 (NO. 17), SEP 22, 2022 社區(qū)獲得性產(chǎn) ESBLs大腸埃希菌感染 －危險因素 社區(qū)獲得性產(chǎn) ESBLs大腸埃希菌感染 －危險因素 其中兩大危險因素： 女性 老年人 Clinical Infectious Diseases 2022。50(1):408. 危險因素和預(yù)后 ? 西班牙 13家三甲醫(yī)院 ~6000， 000病人 產(chǎn) ESBL大腸埃希菌引起社區(qū)發(fā)作性敗血癥危險因素的多變量分析 Clin Infect Dis. 2022 Jan 1。 32:1162–71 產(chǎn) ESBLs菌株感染前的抗菌藥物應(yīng)用 Clinical Infectious Diseases 2022。 32:1162–71 產(chǎn) ESBLs菌株感染： 抗菌藥物的選擇 ? 產(chǎn) ESBLs菌株感染：非碳青霉烯類抗生素治療病死率高于碳青霉烯類抗生素 ? 頭孢菌素治療與產(chǎn) ESBLs菌株血行感染療效較差 ? 頭孢菌素治療對其敏感的產(chǎn) ESBLs菌株的嚴(yán)重感染療效仍差 ? 但起始選擇頭孢菌素，后根據(jù)藥敏更改治療方案并不影響病死率 ? 更慎重的選擇碳青霉烯類抗生素作為治療產(chǎn) ESBLs菌株感染的起始治療的合理性！ – 根據(jù)病人的疾病及病情 – 根據(jù)微生物的耐藥性 ? Reference： – CheolIn Kang et al. Bloodstream Infections Due to ExtendedSpectrum BetaLactamaseProducing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Oute, with Special Emphasis on Antimicrobial Therapy. AAC. 2022, 48,(12),p. 4574–4581 – Schiappa et al. Ceftazidimeresistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a casecontrol and molecular epidemiologic investigation. J. Infect. Dis. 1996. 174:529–536. – WongBeringer et al. Molecular correlation for the treatment outes in bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae with reduced susceptibility to ceftazidime. Clin. . 2022. 34:135–146. – Lautenbach, E., et al. Extendedspectrum –betalactamaseproducing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outes. Clin. Infect. Dis. 2022. 32:1162–1171. – DAVID L. PATERSON,et al. Oute of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing ExtendedSpectrum bLactamases: Implications for the Clinical Microbiology 2022,39:22062212 產(chǎn) ESBLs菌株感染的危險因素 Clinical Infectious Diseases 2022。 39:31–7 碳青霉烯類抗生素 產(chǎn) ESBLs菌株血行感染： 不同抗菌藥物 經(jīng)驗(yàn)性治療療效比較 ? 不同抗菌藥物治療方案 30天 病死率 比較 ： Thirtyday mortality rates – 碳青霉烯類 % (8 of 62) – 頭孢菌素 % (7 of 26) – 氨基糖苷類 % (7 of 26) 選擇 碳青霉烯類抗生素 作為產(chǎn) ESBLs菌株感染的經(jīng)驗(yàn)性治療的合理性！ Bloodstream Infections Due to ExtendedSpectrum BetaLactamaseProducing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Mortality and Treatment Oute, with Special Emphasis on Antimicrobial Therapy. AAC. 2022, 48,(12),p. 4574–4581 存活率 產(chǎn) ESBLs菌株血行感染： 不同抗菌藥物 經(jīng)驗(yàn)性治療療效比較 ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, June 2022, p. 1987–1994 Clinical Infectious Diseases 2022。 40:4666–9. – Quale JM, et al. Molecular epidemiology of a citywide outbreak of extendedspectrum blactamase–producing Klebsiella pneumoniae infection. Clin Infect Dis 2022。g/ml)* Agents CLSIS19 (2022) CLSIS20 (2022) S It R S I R Cefazolin ≤8 16 ≥32 ≤1 2 ≥4 Cefotaxime ≤8 1632 ≥64 ≤1 2 ≥4 Ceftizoxime ≤8 1632 ≥64 ≤1 2 ≥4 Ceftriaxone ≤8 1632 ≥64 ≤1 2 ≥4 Ceftazidime ≤8 16 ≥32 ≤4 8 ≥16 Aztreonam ≤8 16 ≥32 ≤4 8 ≥16 CLSI M100S