泌尿道产ESBLs大肠埃希菌医院感染危险因素病例对照及干预措施研究

A case-control study of risk factors of nosocomial urinary tract hinfectiondue to ESBLs-producing Escherichia coli and the measures for intervention

目的探究泌尿道产ESBLs大肠埃希菌医院感染的危险因素及控制效果。方法将46例泌尿道产ESBLs大肠埃希菌医院感染患者设为观察组，按照1：1比例选同病种同病区非产ESBLs大肠埃希菌医院感染患者为对照组，通过病例对照研究，以条件Logistic法筛选出泌尿道产ESBLs大肠埃希菌医院感染危险因素，并针对这些因素采取相应的控制措施，前瞻性观察感染控制效果。结果住院时间长、泌尿道留置引流管、先期使用第3代头孢菌素及使用多种抗菌药物（≥3种）经单因素和多因素分析有统计学意义；采取相应控制措施后，在泌尿道大肠埃希菌医院感染病例中，产ESBLs菌株检出率从2011年的57％降至2012年的31％。结论住院时间长、泌尿道留置引流管、先期使用第3代头孢菌素及使用多种抗菌药物（≥3种）是泌尿道产ESBLs大肠埃希菌医院感染的独立危险因素。加强对产ESBLs菌株的认识、切断传播途经、严格控制广谱抗生素的使用、 正确留置尿路引流管、缩短患者住院时间是控制泌尿道产ESBLs大肠埃希菌医院感染的有效措施。

Objective To explore the risk factors and control effects of nosocomial urinary tract infection due to ESBLs-producing Escherichia coli. Methods 46 patients with nosocomial urinary tract infection due to ESBLs-producing Escherichia col/were assigned to the study group, and another 46 patients with the same urinary tract infection not due to ESBLs-producing Escherichia coli were assigned to the control group. A case-control study was conducted. Conditional logistic regression was used to screen the risk factors of nosocomial urinary tract infection due to ESBLs-producing Escherichia coli; and the corresponding control techniques were applied to assess the results of infection control prospectively. Pa^ulta Longer length of hospital stay, uses of indwelling urinary tube, early use of the third generation cephalosperin, and use of multiple antibacterials （≥ 3 types） had a statistical significance by univariate and multi-univariate analysis. After the corresponding control measures were taken, the detection rate of ESBLs-producing strains of Escherichia coli declined from 57% in 2011 to 31% in 2012. Coaduaios Longer length of hospital stays, use of indwelling urinary tube, early use of the third generation cephalosporin, and use of multiple antibacterials （ ≥ 3 types） are the independent risk factors for nosocomial urinary tract infection due to ESBLs-producing Escherichia coli. Strengthened awareness of ESBLs-producing strains, termination of transmission route, strict control of broad-spectrum antibiotic uses, correct placement of urinary tube, and shorter length of hospital stay are effective measures for controlling nosocomial urinary tract infection due to ESBLs-producing Escherichia coli.