胆道感染产超广谱β-内酰胺酶菌的耐药性分析

Analysis of drug resistance of extended spectrumβ-lactamasesproducing strains in biliary tract infection

目的探讨医院近5年胆道感染产超广谱β-内酰胺酶(ESBLs)菌的耐药性和其危险因素,并为临床经验性治疗用药提供参考依据。方法对2007-2011年收集的216例胆汁细菌培养结果为革兰阴性菌的胆道感染患者进行分析,其中产ESBLs菌胆道感染患者97例作为观察组,非产ESBLs菌胆道感染患者119例作为对照组,对两组胆道感染细菌的耐药性进行比较,并采用单因素分析和多因素logistic回归分析ESBLs菌株致胆道感染的危险因素。结果 216株革兰阴性菌中大肠埃希菌155株占71.76%;检出产ESBLs菌97株,其中大肠埃希菌82株占84.54%;产ESBLs组对头孢菌素等多种抗菌药物的耐药性均显著高于非产ESBLs组,差异有统计学意义(P<0.01)。结论胆道产ESBLs菌株的耐药比率较高,临床上要严格掌握ERCP操作治疗的适应证,合理应用抗菌药物,注意控制第三代头孢菌素类抗菌药物的应用,可减少产ESBLs细菌感染的发生。

OBJECTIVE To explore drug resistance and risk factors of extended spectrum β‐lactamases （ESBLs）‐producing strains in biliary tract infection in our hospital during last five years and provide a basis for clinical em‐pirical treatment .METHODS The data of 216 patients with biliary tract infection whose bile bacterial culture showed gram -negative bacteria infection from 2007 to 2011 were analyzed .The 97 patients with bile infection caused by ESBLs‐producing bacteria were set as the observation group ,the 119 patients with bile infection caused by non ESBLs‐producing bacteria were set as the control group .The drug resistance was compared between the two groups ,and the logistic regression analysis was adopted to investigate the clinical risk factors for biliary tract infection caused by ESBLs‐producing strains .RESULTS Most of gram‐negative bacteria were Escherichiacoli （155 strains ,71 .76% ） .The positive rate of ESBLs‐producing strains was 44 .91% （97 strains） ,including E .coli ac‐counting for 84 .54% .The resistant rates of ESBLs‐producing strains to multiple antibiotics were significantly higher than those of non ESBLs‐producing ones （P〈0 .01） .CONCLUSION The drug resistance of ESBLs‐produ‐cing strains in biliary duct is high .Clinicians should strictly master the indications of ERCP procedures and ration‐ally use antibiotics and pay attention to controlling the use of the third generation Cephalosporins ,which can reduce the infection caused by ESBLs‐producing strains .