Background

Little is known of the long-term risks of bloodstream infection (BSI) with extended spectrum β-lactamase–producing Enterobacteriaceae (EPE) in previously-colonized individuals. We investigated EPE-BSI risks and associated risk factors during 6 years following EPE colonization.

Methods

We performed a population-based cohort study in Sweden using national health registers. Subjects were followed from their first EPE finding in feces (n = 5513) or urine (n = 17189). The effects of co-morbidity, sociodemography, and outpatient antibiotic dispensation on EPE-BSI risks were assessed. The EPE-BSI risks were compared to those of 45161 matched population–based reference subjects.

Results

The cumulative 6-year EPE-BSI incidences were 3.8%, 1.6%, and 0.02% in the urine, feces, and reference cohorts, respectively. The incidences decreased exponentially during the first 6–12 months. Among EPE-exposed subjects, urological disorders were associated with the highest adjusted cause–specific hazard ratio (aCSHR) for subsequent EPE-BSIs (3.40, 95% confidence interval 2.47–4.69). The aCSHRs were between 1.62–2.20 for male sex, immunosuppression, diabetes, malignancy, lung disease, baseline urine source, and Klebsiella pneumoniae, compared to the Escherichia coli baseline sample. Antibiotics with selective activity against gram-negative bacilli—but mostly not EPE (trimethoprim-sulfamethoxazole, fluoroquinolones, oral cephalosporins, and penicillins with extended spectrums)—and pivmecillinam were associated with doubled EPE BSI risk during the 3 months after antibiotic dispensation in EPE-colonized subjects.

Conclusions

EPE in urine or feces is a substantial risk factor for subsequent EPE-BSIs, but the risk declines rapidly during the first year after detection. In EPE-colonized individuals, specific risk factors can be used to identify subgroups for targeted interventions, such as eradication therapy.

中文翻译：

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以前被定殖的个体中广谱产生β-内酰胺酶的细菌血流感染的时间动态和危险因素：基于全国人群的队列研究

背景

对于先前定殖的个体，产生广谱β-内酰胺酶的肠杆菌科（EPE）引起的血流感染（BSI）的长期风险知之甚少。我们调查了EPE定植后6年内的EPE-BSI风险和相关的危险因素。

方法

我们使用国家卫生登记册在瑞典进行了一项基于人群的队列研究。从首次发现粪便（n = 5513）或尿液（n = 17189）的EPE开始追踪受试者。评估了合并症，社会人口统计学和门诊抗生素分配对EPE-BSI风险的影响。将EPE-BSI风险与45161名匹配的基于人群的参考受试者的风险进行了比较。

结果

尿液，粪便和参考人群的6年期EPE-BSI累积发生率分别为3.8％，1.6％和0.02％。在头6到12个月内，发病率呈指数下降。在暴露于EPE的受试者中，泌尿科疾病与随后的EPE-BSI的最高调整后的因果特定危险比（aCSHR）相关（3.40，95％置信区间2.47-4.69）。与大肠杆菌基线样本相比，男性，免疫抑制，糖尿病，恶性肿瘤，肺病，基线尿源和肺炎克雷伯菌的aCSHRs在1.62至2.20之间。对革兰氏阴性杆菌具有选择性活性的抗生素，但对EPE大多无效（甲氧苄啶-磺胺甲恶唑，氟喹诺酮类药物，口服头孢菌素，

结论

尿液或粪便中的EPE是随后发生EPE-BSI的重要风险因素，但在发现后第一年，该风险迅速下降。在EPE殖民化的个体中，特定的危险因素可用于识别针对性干预措施（例如根除疗法）的亚组。