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首页> 外文期刊>Antimicrobial agents and chemotherapy. >Clinical characteristics of bloodstream infections due to ampicillin-sulbactam-resistant, non-extended- spectrum-beta-lactamase-producing Escherichia coli and the role of TEM-1 hyperproduction.
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Clinical characteristics of bloodstream infections due to ampicillin-sulbactam-resistant, non-extended- spectrum-beta-lactamase-producing Escherichia coli and the role of TEM-1 hyperproduction.

机译：产生氨苄西林-舒巴坦抗性，非扩展谱-β-内酰胺酶的大肠杆菌引起的血流感染的临床特征以及TEM-1高产的作用。

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Ampicillin-sulbactam is commonly used as an empirical therapy for invasive infections where Escherichia coli is a potential pathogen. We evaluated the clinical and microbiologic characteristics of bloodstream infection due to E. coli, with focus on cases that were nonsusceptible to ampicillin-sulbactam and not producing extended-spectrum beta-lactamase (ESBL). Of a total of 357 unique bacteremic cases identified between 2005 and 2008, 111 (31.1%) were intermediate or resistant to ampicillin-sulbactam by disk testing. In multivariate analysis, a history of liver disease, organ transplant, peptic ulcer disease, and prior use of ampicillin-sulbactam were independent risk factors for bloodstream infection with ampicillin-sulbactam-nonsusceptible E. coli. Among cases that received ampicillin-sulbactam as an empirical therapy, an early clinical response was observed in 65% (22/34) of susceptible cases but in only 20% (1/5) of nonsusceptible cases. Among 50 ampicillin-sulbactam-resistant isolates examined, there was no clonal relatedness and no evidence of production of inhibitor-resistant TEM (IRT). Instead, the resistance was attributed to hyperproduction of TEM-1 beta-lactamase in the majority of isolates. However, promoter sequences of bla(TEM-1) did not predict resistance to ampicillin-sulbactam. While the plasmid copy number did not differ between representative resistant and susceptible isolates, the relative expression of bla(TEM-1) was significantly higher in two of three resistant isolates than in three susceptible isolates. These results suggest high-level bla(TEM-1) expression as the predominant cause of ampicillin-sulbactam resistance and also the presence of yet-unidentified factors promoting overexpression of bla(TEM-1) in these isolates.
机译：氨苄西林舒巴坦通常用作侵袭性感染的经验疗法，其中大肠杆菌是潜在的病原体。我们评估了因大肠杆菌引起的血液感染的临床和微生物学特征，重点是对氨苄西林舒巴坦不敏感且不产生广谱β-内酰胺酶（ESBL）的病例。在2005年至2008年之间鉴定的357例独特细菌病例中，有111例（31.1％）通过盘片检测对氨苄西林舒巴坦具有中等或耐药性。在多变量分析中，肝病，器官移植，消化性溃疡病以及先前使用氨苄西林舒巴坦的病史是氨苄西林-舒巴坦不敏感的大肠杆菌感染血流的独立危险因素。在接受氨苄西林-舒巴坦作为经验疗法的病例中，在65％（22/34）的易感病例中观察到早期临床反应，但在不敏感的病例中仅观察到20％（1/5）。在检查的50株对氨苄西林-舒巴坦耐药的菌株中，没有克隆相关性，也没有产生抗耐药性TEM（IRT）的证据。相反，该抗性归因于大多数分离株中TEM-1β-内酰胺酶的高产。但是，bla（TEM-1）的启动子序列不能预测对氨苄西林舒巴坦的耐药性。尽管代表性的耐药菌株和易感菌株之间的质粒拷贝数没有差异，但在三种耐药菌株中，有两种的bla（TEM-1）相对表达明显高于三种易感菌株。这些结果表明高水平的bla（TEM-1）表达是氨苄西林-舒巴坦耐药的主要原因，并且在这些分离物中还存在尚未确定的促进bla（TEM-1）过表达的因素。

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