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首页> 外文期刊>Antimicrobial agents and chemotherapy. >Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbapenemase, molecular characterization, epidemiology, and outcomes.
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Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbapenemase, molecular characterization, epidemiology, and outcomes.

机译：耐亚胺培南肠杆菌的分离：KPC-2碳青霉烯酶的出现，分子特征，流行病学和结果。

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The prevalence of isolation of imipenem-resistant Enterobacter (IRE) strains is rising, with potential serious consequences in terms of patients' outcomes and general care. The study objective was to define the various epidemiological aspects of the isolation of these strains in comparison to cases of isolation of imipenem-susceptible Enterobacter (ISE) strains. Molecular analysis of IRE strains included genotyping and defining the presence of carbapenemases. We conducted a matched retrospective case-control study of patients hospitalized from April 2003 to December 2006. Each IRE case was matched with an ISE case by age and source of isolation. A multivariate analysis using conditional logistic regression was performed to compare the two patient groups. There were 33 cases of IRE isolations during the study period. Twenty isolates were analyzed and found to belong to three distinct pulsotypes. Cell extracts of all of these isolates hydrolyzed imipenem. PCR and sequencing revealed that these isolates harbored a KPC-2 gene. In multivariate analysis, a high invasive-device score (P 0.02) remained a predictor of IRE isolation. The mortality in the IRE group was 33%, compared to 9% among controls. Being an IRE case was significantly associated with increased mortality after controlling for confounders in a multivariate model (odds ratio, 8.3 +/- 8.6; 95% confidence interval, 1.07 to 64; P = 0.043). Resistance to imipenem due to bla(KPC-2) among Enterobacter isolates has occurred in several clones in Tel Aviv, affecting particularly patients with multiple invasive devices compared to ISE controls. IRE infections are associated with increased mortality. Enhanced measures to control the hospital spread of IRE are warranted.
机译：耐亚胺培南的肠杆菌（IRE）菌株的分离患病率正在上升，这可能对患者的预后和一般护理产生严重的后果。与分离亚胺培南敏感肠杆菌（ISE）菌株的病例相比，研究目的是确定分离这些菌株的各种流行病学方面。 IRE菌株的分子分析包括基因分型和定义碳青霉烯酶的存在。我们对2003年4月至2006年12月住院的患者进行了匹配的回顾性病例对照研究。每个IRE病例均按年龄和隔离源与ISE病例匹配。进行了使用条件逻辑回归的多元分析，以比较两个患者组。在研究期间，有33例IRE隔离病例。分析了二十个分离株，发现它们属于三种不同的脉冲型。所有这些分离物的细胞提取物都水解了亚胺培南。 PCR和测序表明，这些分离株具有KPC-2基因。在多变量分析中，高侵入性器械评分（P 0.02）仍然是IRE隔离的预测指标。 IRE组的死亡率为33％，而对照组为9％。在多变量模型中控制混杂因素后，成为IRE病例与死亡率增加显着相关（赔率，8.3 +/- 8.6; 95％置信区间，1.07至64; P = 0.043）。在特拉维夫的几个克隆中，肠杆菌中的bla（KPC-2）对亚胺培南具有抗药性，与ISE对照相比，它特别影响具有多种侵入性装置的患者。 IRE感染与死亡率增加有关。必须采取加强措施来控制IRE在医院的传播。

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