Abstract：
Background: The prevalence of community-onset infections of extended spectrum β-lactamase (ESBL)-producing strains has increased globally, yet surveillance and resistance in patients with oral and maxillofacial surgery site infections is less investigated. Patients and Methods: A retrospective cohort study was performed to investigate risk factors and resistance of ESBL-producing Escherichia coli (ESBL-EC) and ESBL-producing Klebsiella pneumonia (ESBL-KP) among community-onset patients with oral and maxillofacial surgery during January 2010 to December 2016. Demographic features, predisposing factors, clinical outcomes, and antibiotic agent costs were analyzed. Antimicrobial susceptibility testing of nine antimicrobial agents against ESBL-KP and ESBL-EC were measured. Results: Among 2,183 cultures from infection sites in patients with oral and maxillofacial surgery site (45 cases [2.06%]) were confirmed with community-onset ESBL-KP (24; 1.10%) or ESBL-EC (21; 0.96%) infection. Multivariable analysis showed the independent risk factors for ESBL-producing bacterial infection were prior history of hospitalization (adjusted odds ratio [aOR], 10.984; 95% confidence interval [CI], 5.965-59.879; p = 0.025) and malignant condition (aOR, 3.373; 95% CI 2.947-7.634; p = 0.024). Based on antimicrobial susceptibility testing, 57.8% ESBL-KP and ESBL-EC were found receiving inappropriate antimicrobial therapy, and antibiotic agent costs were higher than non-ESBL-producing bacterial infections ($493.8 ± $367.3 vs. $304.1 ± $334.7; p = 0.031). Conclusions: Infections caused by ESBL-KP and ESBL-EC among patients in sites with oral and maxillofacial surgery are associated with prior history of hospitalization and malignant conditions. Prompt detection and appropriate antibiotic administration for community-onset infections of ESBLs are necessary for such populations.
摘要：
背景：产超广谱β-内酰胺酶（ESBL）菌株的社区感染患病率在全球范围内有所增加，然而，对口腔颌面手术部位感染患者的监测和耐药性研究较少。患者和方法：采用回顾性队列研究方法，调查2010年1月至2016年12月社区口腔颌面外科患者产ESBL大肠埃希菌（ESBL-EC）和肺炎克雷伯菌（ESBL-KP）的危险因素和耐药性。人口统计特征，诱发因素,临床结果，并对抗生素制剂成本进行了分析。测定了9种抗菌药物对ESBL-KP和ESBL-EC的药敏试验。结果：在口腔颌面外科患者感染部位的2183个培养物中（45例[2.06％]）被证实为社区发作的ESBL-KP（24；1.10％）或ESBL-EC（21；0.96％）感染。多变量分析显示，产ESBL细菌感染的独立危险因素是既往住院史（校正比值比[aOR]，10.984；95%置信区间[CI]，5.965-59.879；p=0.025）和恶性状况（aOR，3.373；95%CI2.947-7.634；p=0.024）。根据抗菌药物敏感性试验,57.8％的ESBL-KP和ESBL-EC被发现接受不适当的抗菌治疗，抗生素药物成本高于非ESBL产生的细菌感染（$493.8±$367.3vs.$304.1±$334.7；p=0.031）。结论：口腔颌面外科患者中由ESBL-KP和ESBL-EC引起的感染与先前的住院史和恶性状况有关。对于这些人群，有必要对ESBLs的社区发作性感染进行及时检测和适当的抗生素给药。
