【medical-news】CID：经直肠超声引导前列腺穿刺活检患者中氟喹诺酮抵抗性大肠埃希菌的血液感染多为ST131亚型

Escherichia coli BloodstreamInfection After Transrectal Ultrasound–Guided Prostate Biopsy: Implications ofFluoroquinolone-Resistant Sequence Type 131 as a Major Causative Pathogen

CID：经直肠超声引导前列腺穿刺活检患者中氟喹诺酮抵抗性大肠埃希菌的血液感染 http://cid.oxfordjournals.org/content/54/10/1406.abstract

Background. Transrectal ultrasound–guided (TRUS) prostatebiopsy is a commonly performed procedure, and fluoroquinolones are the mostfrequently given prophylactic antimicrobials. In the context of increasing fluoroquinolone resistance, and the internationalemergence of fluoroquinolone-resistant sequence type 131 (ST131) Escherichiacoli, we describe a large series of E. coli bacteremia after TRUS biopsy.

经直肠超声引导(TRUS)前列腺穿刺活检是常见的检测手段，氟喹诺酮是常见的预防性抗菌剂。随着氟喹诺酮抗性问题的日趋严重，以及氟喹诺酮抗性序列131亚型(ST131)大肠杆菌在世界范围的广泛出现，我们发现了一系列TRUS活组织检查后发生的大肠杆菌菌血症。

Methods. All male patients admitted with community-onset (CO) E. colibacteremia from January 2006 through December 2010 were included. Patientcharacteristics, treatment outcomes, and rates of antimicrobial resistance werecompared between patients with TRUS biopsy–related bacteremia and other malepatients with CO E. coli bacteremia. Molecular typing was performed on E. coliisolates to determine phylogenetic group.

试验纳入2006年1月至2010年12月经大肠杆菌菌落检验证实的男性菌血症患者。试验比较了TRUS活组织检查引起的菌血症和其它大肠杆菌菌血症的患者特征，治疗结果，抗菌剂抗性率。并对大肠杆菌单菌落进行分子定型以确定其种系。

Results. A total of 258 male patients were admitted withCO E. coli bacteremia. Of these, 47 patients (18%) were admitted after TRUS biopsy. Patients who had undergone TRUS biopsy were twice aslikely to require intensive care admission (25% vs 12%) and had significantlyhigher rates of resistance to gentamicin (43%), trimethoprim-sulphamethoxazole(60%), and ciprofloxacin (62%) as well as all 3 agents incombination (19%). Thirty-six percent of post–TRUS biopsy patients did notreceive active empirical antibiotic therapy. The ST131 clone accounted for 41%of all E. coli isolates after TRUS biopsy.

结果显示，总共有258例大肠杆菌菌血症男性患者被确诊，其中47例(18%)为TRUS活组织检查后被确诊。接受过TRUS活组织检查的患者重症监护率(25% vs12%)是其它大肠杆菌菌血症的2倍，对庆大霉素的抗性率(43%)，甲氧苄氨嘧啶-磺胺甲恶唑抗性率(60%)，以及环丙沙星抗性率(62%)，其它3种复合因子抗性率(19%)也更高，且差异有显著性。36%的TRUS 活组织检查后患者没有接受活性常用抗生素治疗。41%的TRUS活组织检查后患者的大肠杆菌菌落显示为ST131菌株。

Conclusions. E. coli bacteremia can bea life-threatening complication of TRUS biopsy. Infecting strains arefrequently multidrug-resistant and resistant to common empirical antibioticagents. E. coli ST131 is an important cause ofsepsis after TRUS biopsy. Further studies should evaluate colonization withfluoroquinolone-resistant E. coli as a risk factor for postbiopsy sepsis.

结论：大肠杆菌菌血症是TRUS活组织检查后的致命并发症。感染菌株往往具有多药耐药性并对常用抗菌剂产生耐性。大肠杆菌ST131是TRUS活组织检查后迸发脓血症的重要原因。进一步的研究将评估氟喹诺酮抗性大肠杆菌定植情况以确定是否活检后脓血症的危险因子。

经直肠超声引导(TRUS)前列腺穿刺活检是常见的检测手段，氟喹诺酮是常见的预防性抗菌剂。随着氟喹诺酮抗性问题的日趋严重，以及氟喹诺酮抗性序列131亚型(ST131)大肠杆菌在世界范围的广泛出现，我们发现了一系列TRUS活组织检查后发生的大肠杆菌菌血症。

试验纳入2006年1月至2010年12月经大肠杆菌菌落检验证实的男性菌血症患者。试验比较了TRUS活组织检查引起的菌血症和其它大肠杆菌菌血症的患者特征，治疗结果，抗菌剂抗性率。并对大肠杆菌单菌落进行分子定型以确定其种系。

结果显示，总共有258例大肠杆菌菌血症男性患者被确诊，其中47例(18%)为TRUS活组织检查后被确诊。接受过TRUS活组织检查的患者重症监护率(25% vs12%)是其它大肠杆菌菌血症的2倍，对庆大霉素的抗性率(43%)，甲氧苄氨嘧啶-磺胺甲恶唑抗性率(60%)，以及环丙沙星抗性率(62%)，其它3种复合因子抗性率(19%)也更高，且差异有显著性。36%的TRUS 活组织检查后患者没有接受活性常用抗生素治疗。41%的TRUS活组织检查后患者的大肠杆菌菌落显示为ST131菌株。

结论：大肠杆菌菌血症是TRUS活组织检查后的致命并发症。感染菌株往往具有多药耐药性并对常用抗菌剂产生耐性。大肠杆菌ST131是TRUS活组织检查后迸发脓血症的重要原因。进一步的研究将评估氟喹诺酮抗性大肠杆菌定植情况以确定是否活检后脓血症的危险因子。