产超广谱β-内酰胺酶大肠埃希菌感染的危险因素分析

Risk factors for infections caused by extended-spectrum β-lactamase-producing Escherichia coli

目的分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(ECO)的临床特征,评估其感染危险因素,为制定预防医院感染策略提供科学依据。方法采用病例对照研究,收集医院2013年3-6月住院患者送检标本检出的非重复ECO 278株,采用VITEK-2Compact全自动微生物分析仪进行细菌鉴定及药敏试验,采用双纸片协同试验对检测出的产ESBLs-ECO进行确证试验,采用χ2检验和logistic回归模型对产ESBLs-ECO感染危险因素进行统计分析。结果 278株ECO中产ESBLs-ECO 172株,占61.9%;产ESBLs-ECO主要分离自尿液、分泌物和血液,病房分布主要以泌尿外科、妇科和胃肠外科为主,分别占15.7%、14.0%、11.7%;住院>10d、手术、灌肠、导尿置管、引流置管、使用皮质激素、使用抗菌药物(尤其头孢类药物)是产ESBLs-ECO医院感染的主要危险因素(P<0.05);引流置管和头孢类药物使用为独立危险因素。结论产ESBLs-ECO检出率较高,医院应根据危险因素加强医院感染管理,尤其是规范引流管操作和慎用头孢类抗菌药物,减少产ESBLs-ECO感染的发生。

OBJECTIVE To analyze the clinical characteristics of extended‐spectrum β‐lactamase （ESBLs）‐producing Escherichia coli and observe the risk factors for infections so as to provide scientific basis for prevention of nosoco‐mial infection .METHODS By means of case‐control study ,totally 278 strains of non‐repetitive E .coli were isolated from the submitted specimens that were obtained from the patients who were hospitalized from Mar 2013 to Jun 2013 ,then the bacterial identification was carried out by using VITEK‐2 Compact automatic microorganism analy‐zer ,the drug susceptibility testing was performed ,the confirmatory test was conducted for the isolated ESBLs‐producing E .coli with the use of double disk synergy test ,and the risk factors for the ESBLs‐producing E .coli in‐fections were statistically analyzed by using the chi‐square test and logistic regression model .RESULTS A total of 172 strains of ESBLs‐producing E .coli were identified among the 278 strains of E .coli ,accounting for 61 .9% . The ESBLs‐producing E .coli strains were mainly isolated from the urine ,secretions ,and blood .Among the isola‐ted ESBLs‐producing E .coli strains ,15 .7% were isolated from the urology department ,14 .0% from the gynecol‐ogy department ,11 .7% from the gastroenterology department .The leading risk factors for the ESBLs‐producing E .coli infections included the length of hospital stay more than 10 days ,surgery ,clyster ,urinary catheterization , drainage intubation ,use of corticosteroids ,and use of antibiotics ,cephalosporins in particularly （P〈0 .05）;the drainage intubation and use of cephalosporins were the independent risk factors .CONCLUSION The isolation rate of the ESBLs‐producing E .coli is high .It is necessary for the hospital to strengthen the control of nosocomial in‐fections according to the risk factors ,focus on the standard operation of drainage tubes ,and reasonably use cepha‐losporins so as to reduce the incidence of ESBLs‐producing E .coli infections .