外科ICU产ESBLs大肠埃希菌感染临床调查及耐药性分析

Clinical investigation of ESBLs-producing Escherichia coli infections in surgical ICU and analysis of drug resistance

目的调查外科ICU产超广谱β-内酰胺酶(ESBLs)大肠埃希菌感染的临床特征及耐药性,分析其流行趋势,为有效预防和控制产ESBLs大肠埃希菌医院感染提供参考资料。方法回顾性研究2009-2011年医院外科ICU非重复分离的54株产ESBLs大肠埃希菌感染病例临床资料及药敏试验数据,分析其流行特征及耐药性。结果 2009-2011年外科ICU分离的大肠埃希菌中,产ESBLs菌株分别占57.6%、60.0%和53.1%;感染病例以老年患者居多,占77.8%;感染类型以泌尿系感染和腹腔感染为主,分别占22.2%、20.4%,其次为血液感染及肺部感染,各占18.5%;产ESBLs大肠埃希菌对碳青霉烯类抗菌药物均敏感,哌拉西林/他唑巴坦和阿米卡星耐药率分别为19.4%和7.4%,显示较好的抗菌活性,其余抗菌药物耐药率均较高。结论加强ICU产ESBLs大肠埃希菌的目标性监测,有利于预防和控制医院感染的传播流行。

OBJECTIVE To investigate the clinical characteristics of the extended spectrum β-lactamases （ESBLs）-producing Escherichia coli isolated from surgical ICU, observe the drug resistance, and analyze the epidemic tendency so as to provide reference for prevention and control of nosocomial infections. METHODS The clinical data ofpatients with infections caused by 54 strains of non-repetitive ESBLs-producing Escherichia coli isolated from thesurgical ICU were retrospectively studied between 2009 and 2011,the data of drug susceptibility testing were ob-served, and the epidemiological characteristics and the drug resistance were analyzed. RESULTS Of the E. colistrains isolated from the surgical ICU from 2009 to 2011,the ESBLs-producing strains accounted for 57% ,60.0% and 53. 1 %,respectively. The senile was the majority of the infection cases,accounting for 77. 8%. The uri-nary tract and the abdominal cavity were the main infection sites,accounting for 22. 2% and 20. 4%,followed bythe blood （18. 5%） and the lung （18. 5%）. The ESBLs-producing E. coli strains were sensitive to carbapenems,the drug resistance rates to piperacillin-tazobactam and amikacin were 19. 4% and 7. 4% , respectively, showinggood antibacterial activity, and the strains were highly resistant to the rest of the antibiotics. CONCLUSION It maybenefit the prevention and control of nosocomial infections by strengthening the targeted monitoring of ESBLs-producing E, coli in ICU.