产超广谱β-内酰胺酶细菌的耐药性及其致医院获得性下呼吸道感染的危险因素

Nosocomial lower respiratory tract infection caused by extended-spectrum β-lactamases-producing bacteria： drug resistance and risk factors

目的探讨产超广谱β-内酰胺酶（ESBLs）细菌的耐药性及其致医院获得性下呼吸道感染的危险因素。方法选取浙江省青田县人民医院2008年7月-2011年12月ESBLs^＋菌引起的医院获得性下呼吸道感染病例80例，并按数字表法随机选择同期160例ESBLs-菌医院感染者作为对照组。采用单因素分析及多因素Logistic回归分析其危险因素，并使用K—B纸片琼脂扩散法测定其对16种抗菌药物的耐药性。结果单因素分析发现，住院时间≥10d，转入院或再次入院，给氧，侵入性操作，使用抗酸剂、糖皮质激素、免疫抑制剂〉7d，使用第三代头孢菌素，使用氟喹诺酮类药物及联合应用抗菌药物1〉3d与医院获得性下呼吸道ESBLs’菌感染有关。多因素Logistic回归分析发现，给氧（OR=8．613，95％CI：1．870—39．659）、侵入性操作（OR=5．900，95％CI：1．885～18．467）、使用第三代头孢菌素（OR=7．465，95％CI：2．364—23．578）、使用氟喹诺酮类药物（OR=4．481，95％CI：1．197～16．781），以及联合应用抗菌药物≥3d（OR=5．346，95％CI：1．717～16．643）是医院获得性下呼吸道ESBLs’菌感染的独立危险因素。ESBLs^＋大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南、头孢哌酮／他唑巴坦及哌拉西林／他唑巴坦的耐药率较低（〈30．00％），对大部分β-内酰胺类、氨基糖苷类、氟喹诺酮类及磺胺类药物的耐药率较高。结论医院获得性下呼吸道ESBLs’菌感染主要与医院的侵入性操作及抗菌药物的使用有关，ESBLs’分离的耐药率较高。

Objective To investigate the antibiotic resistance of extended-spectrum β-lactamases （ESBLs）-producing bacteria, and the risk factors for patients with hospital-acquired lower respiratory tract infections caused by these bacteria. Methods The clinical data of 80 cases of hospital-acquired lower respiratory tract infections caused by ESBLs^＋ bacteria in the People＇ s Hospital of Qingtian in Zhejiang Province from July 2008 to December 2011 were collected; and 160 cases of nosocomial infection caused by ESBLs bacteria were randomly selected as controls. Univariate analysis and multivariate logistic regression were used to analyze the risk factors for ESBLs^＋ bacteria infection. The resistance of sixteen antibiotics was detected by K-B method. Results Univariate analysis revealed that the risk factors for nosocomial lower respiratory tract infection caused by ESBLs ^＋ bacteria were hospitalization ≥ 10 d, readmission to hospital, oxygen inhalation, invasive operations, using antacid 〉 7 d, using glucocorticoids 〉 7 d, using immunosuppressant 〉 7 d, using third-generation cephalosporins, using fluoroquinolone antibacterials, and the combined use of antibiotics ≥3 d. Multivariate logistic regression analysis identified five independent risk factors ： oxygen inhalation （ OR = 8.613, 95% CI： 1. 870-39. 659）, invasive operations （ OR = 5. 900, 95% CI： 1. 885-18.467）, using third-generation cephalosporins （ OR = 7. 465, 95% CI： 2. 364-23. 578 ） , using fluoroquinolone antibacterials （ OR =4. 481, 95% CI： 1. 197-16. 781 ） and combined use of antibiotics≥3 d （ OR = 5. 346, 95% CI： 1. 717-16. 643 ）. ESBLs^＋ Escherichia coli and Klebsiella pneumoniae strains were sensitive to imipenem, meropenem, cefoperazone /sulbactam and piperacillin/tazobactam （with the resistance rates lower than 30. 00% ）, but were highly resistant to most β-1actam, aminoglycoside, fluoroquinolone and sulfonamide antibacterlals. Conclusion ESBLs^＋ isolates were highly resistant to most antibacterials, and hospital-acquired lower respiratory tract infections with ESBLs＋ bacteria are mainly related with invasive operations and the use of antibiotics.