522例产ESBLs大肠埃希菌医院感染的耐药性和危险因素分析

Analysis on drug resistance and risk factors of 522 cases of nosocomial infection with ESBLs Escherichia coli

目的了解产超广谱β-内酰胺酶(extended spectrumβ-laetamases,ESBLs)大肠埃希菌医院感染的耐药性及危险因素,为预防该菌的感染和临床用药选择提供依据。方法调查2012年安徽医科大学第二附属医院产ESBLs大肠埃希菌医院感染的病例,回顾性分析其耐药性和感染的高危因素。结果 2012年度某院共有522例产ESBLs大肠埃希菌医院感染,44.44%源自尿液,22.99%来源于痰液。产ESBLs大肠埃希菌对头孢唑啉、头孢曲松、头孢噻肟的耐药率分别高达100.00%、99.04%、98.47%,对头孢他啶耐药率亦高达82.18%,对头孢西丁的耐药率为19.92%,未发现对碳青霉烯类抗生素亚胺培南和美洛培南的耐药。存在基础疾病、高龄、使用侵袭性操作、使用抗菌药物种类多及时间长、住院天数长都是产ESBLs大肠埃希菌医院感染的高危因素,而性别为非高危因素。结论产ESBLs大肠埃希菌医院感染对头孢唑啉、头孢曲松、头孢噻肟、头孢他啶耐药率高,对头孢西丁耐药率低,对亚胺培南和美洛培南敏感。应针对住院患者基础疾病、高龄、使用侵袭性操作、使用抗菌药物种类多及时间长、住院天数长这些危险因素采取干预措施,以预防该菌感染。

Objective To understand the drug resistance and risk factors of nosocomial infections with ESBLs Escherichia coli, in order to provide basis for preventing bacterial infection, and clinical medication. Methods ESBLs Escherichia coli infection cases of the second hospital affiliated to Anhui medical university in 2012 were surveyed, and retrospectively analyzed its drug resistance and infection risk factors. Results There were total 522 cases of ESBLs Escherichia coli infection in our hospital in 2012, and nearly half came from urine（44.44%）, 22.99% of that from sputum. ESBLs Escherichia coli resistance level to cefazolin, ceftriaxone, cefotaxime were as high as 100.00%, 99.04% and 98.14%, respectively. Resistance rate for ceftriaxone and cefoxitin were 82.18% and 19.92%, respectively. And bacteria resistance to imipenem and meropenem was not found. Risk factors for ESBLs Escherichia coli infection include pre-existing diseases, elder, invasive operation, variety use of antibacterial drugs for a long time, and long hospitalization days, while gender was not. Conclusions ESBLs Escherichia coli resistance level to cefazolin, ceftriaxone, cefotaxime and ceftazidime were high, and that to cefoxitin was low. It was sensitive to imipenem and meropenem. Interventions should be applied to hospitalized patients with underlying disease existing, elder, invasive operation, using a variety of antibacterial drugs with a long time, and long hospitalization days to prevent bacterial infection.