Background Escherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing E. coli infections is an ongoing challenge. The clinical characteristics and outcomes of ESBL-producing E. coli bacteremia in non-transplant patients remain to be elucidated. Methods This retrospective study included 491 non-transplant patients with E. coli bloodstream infections (BSIs) from January 2013 to December 2016 and was conducted to investigate the risk factors, clinical features, and outcomes of these infections. Results Of the 491 E. coli BSI patients, 57.6% suffered from infections with ESBL-producing strains. A multivariate analysis showed that urinary tract infection, prior use of cephalosporin, and treatment with β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics were independent risk factors for the development of ESBL-producing E. coli BSIs. The overall mortality rate in E. coli BSI patients was 14.46%, and there was no significant difference in the 28 day mortality rate between ESBL-producing E. coli and non-ESBL-producing E. coli BSI patients (14.8% vs. 14.0%, respectively; P = 0.953). Similarly, there was no difference between the community-acquired infection group and the nosocomial infection group. Hepatobiliary disease, carbapenem exposure, high APACHE II score, and hypoproteinemia were independent risk factors for death in E. coli BSI patients. Multivariate analysis showed that hypoproteinemia and severe disease were independent risk factors for death from ESBL-producing E. coli BSIs. Furthermore, there was no significant difference in the 28 day mortality between patients with ESBL-producing E. coli BSIs treated with carbapenem monotherapy versus those treated with BLBLI combination antibiotics (12.8% vs. 17.9%, respectively; P = 0.384). Conclusions Prior use of cephalosporin or BLBLI combination antibiotics increased the risk ratio for ESBL-producing E. coli infection. Hypoproteinemia and severe disease are independent risk factors for death in patients with E. coli BSIs. There was no significant difference in the 28 day prognosis of patients with ESBL-producing E. coli and those with non-ESBL-producing E. coli BSIs. These data do not support the conclusion that carbapenems might be more effective than BLBLI antibiotics for treatment of patients with BSIs caused by ESBL-producing E. coli.

中文翻译：

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产生广谱β-内酰胺酶的大肠埃希菌菌血症的非移植患者的危险因素和结局：2013年至2016年的一项回顾性研究。

背景技术大肠杆菌是产生广谱β-内酰胺（ESBL）细菌的最常见菌株之一，预防和治疗产生ESBL的大肠杆菌感染是一项持续的挑战。非移植患者中产生ESBL的大肠杆菌菌血症的临床特征和结局仍有待阐明。方法这项回顾性研究纳入2013年1月至2016年12月的491例非移植性大肠杆菌血流感染（BSI）患者，并进行了调查，以探讨这些感染的危险因素，临床特征和结局。结果在491例BSI大肠杆菌患者中，有57.6％的人感染了产生ESBL的菌株。多因素分析显示，尿路感染，先前使用头孢菌素，β-内酰胺-β-内酰胺酶抑制剂（BLBLI）联合治疗和抗生素治疗是产生ESBL的大肠杆菌BSI发展的独立危险因素。大肠杆菌BSI患者的总死亡率为14.46％，生产ESBL的大肠杆菌和不生产ESBL的大肠杆菌BSI患者的28天死亡率没有显着差异（分别为14.8％和14.0％）分别为％； P ＝ 0.953）。同样，社区获得性感染组和医院感染组之间也没有差异。肝胆疾病，碳青霉烯暴露，高APACHE II评分和低蛋白血症是大肠杆菌BSI患者死亡的独立危险因素。多变量分析表明，低蛋白血症和严重疾病是导致ESBL产生的大肠杆菌BSI死亡的独立危险因素。此外，接受碳青霉烯单药治疗的ESBL产大肠杆菌BSI患者与BLBLI联合抗生素治疗的28天死亡率之间无显着差异（分别为12.8％和17.9％； P = 0.384）。结论事先使用头孢菌素或BLBLI联合抗生素会增加产生ESBL的大肠杆菌感染的风险比。低蛋白血症和严重疾病是大肠杆菌BSI患者死亡的独立危险因素。产生ESBL的大肠杆菌患者和未产生ESBL的大肠杆菌BSI患者的28天预后没有显着差异。这些数据不支持这样的结论，即碳青霉烯类药物可能比BLBLI抗生素更有效地治疗由产ESBL的大肠杆菌引起的BSI患者。