大肠埃希菌下呼吸道感染的临床和药敏分析

Analysis of clinical characteristics and drug sensitivity tests of lower respiratory tract infection by Escherichia coli

目的分析和总结大肠埃希菌下呼吸道感染的临床特点及抗生素敏感性的分布情况。方法对40例大肠埃希菌下呼吸道感染的临床资料进行统计分析。采用纸片法 (Kirby-Bauer)测定该菌的体外药物敏感性。若疑为ESBLs,则行确认试验。结果40例中90 % (36/40)患有基础疾病 ,其中慢性阻塞性肺疾病 (COPD)合并呼吸衰竭最常见 ,70 % (28/40)的患者免疫功能低下 ,45 % (18/40)入住ICU或CCU病房 ,22.5 % (9/40)曾接受侵入性治疗 ,95 % (38/40)前期使用过广谱抗生素。临床表现为发热 (65% )、咳嗽 (92.5 % )、咳痰 (80 % ) ,胸部X线多表现为双下肺淡薄斑片状阴影 ,药敏监测表明该菌广泛耐药 ,尤其是产ESBLs株。敏感率>80 %者仅有亚胺培南/西司他丁、哌唑西林/他唑巴坦、头孢他啶、头孢吡肟、丁胺卡那。结论大肠埃希菌下呼吸道感染多发在患有各种基础疾病、免疫功能低下者。细菌耐药现象严重 (尤其在产ESBLs的细菌中 ) 。

Objective To analyze the clinical characteristics of lower respiratory tract infection caused by E.coli and to investigate the antibiotic sensitivity of E.coli strains. Methods Retrospective study of the clinical data of 40 cases with lower respiratory tract infection by E.coli. Drug sensitivity against strains of E.coli by Kirby-Bauer method was studied. Results 90% of the cases had underlying diseases, most of which were COPD complicated by respiratory failure. 70% of the cases were immunocompromised. 45% of the cases were in ICU or CCU, 22.5% of the cases accepted invasive treatments, and 95% of the cases were given broad_spectrum antibiotics. Clinical manifestations include fever(65%), cough(92.5%) and expectoration(80%). The chest X_ray revealed infiltration in lower lobes of both lungs. The drug sensitivity test showed that these strains were multiresistant to commonly used antibiotics(especially in the ESBLs_producing strains) and drugs whose sensitive rate were over 80% included Imipenem/cilastatin, piperacillin/Tazobactam, ceftazidime, cefepime, Amikacin. Conclusions The lower respiratory tract infections causes by E.coli mostly develop in patients with various underlying disease, especially in the immunocompromised patients. Severe resistance of bacteria was exist. In clinical therapy, sensitive antibiotics should be selected based on bacteria culture and the drug sensitive tests.