社区与医院血流感染大肠埃希菌耐药性分析

Resistance analysis of E.coli in the bloodstream infections from community and hospital

目的：了解社区与医院血流感染中大肠埃希菌的耐药性，为临床合理用药提供依据。方法采用法国梅里埃公司的VITEK-2 Compact GN 和 AST-GN14卡进行菌株鉴定和药敏试验，按照 CLSI 2013药敏试验标准执行，采用 SP13.0软件对数据进行分析。结果2014年1-12月社区与医院血流感染中检出大肠埃希菌181株，社区感染88株，医院感染93株。社区感染中产 ESBLs 阳性率（53.4%）显著低于医院感染（73.1%）（P =0.006）。181株大肠埃希菌耐药率低于10%的有头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、厄他培南、亚胺培南、阿米卡星，医院感染菌株耐药率普遍高于社区感染菌株。ICU、泌尿外科血流感染的大肠埃希菌产 ESBLs 阳性率较高。结论医院血流感染大肠埃希菌耐药率高于社区血流感染大肠埃希菌，合理选择用药，加强ICU、外科病房的感染监测是控制细菌耐药性产生的有效措施。

Objective To understand the drug resistance of Escherichiacoli in the bloodstream infections from community infection and hospital infection,in order to provide the basis for clinical rational drug use.Methods According to the CLSI 2013 strandard,VITEK-2GN and AST-GN13 cards from France Bio-merieux company were used to identify the bacteria and analyze the drug susceptibility.The data was analyzed by SPSS 13.0.Results A total of 181 strains of Escherichiacoli were isolated from communi-ty-acquired and hospital-acquired bloodstream infections from January to December in 2014.There were 88 strains of community infection and 93 strains of hospital infection.The rates of ESBLs （＋）strains isolated from community infection and hospital infection were 53.4% and 73.1% respectively.The ESBLs （＋）rate of Escherichiacoli isolated from community infection was significantly lower than that from hospital infection （P =0.006）.Antibiotics of resistance less than 10% in 181 strains of Escherichiacoli were Cefoperazone/Sulbactam,Piperacillin/Tazobactam,Ertapenem,Imipenem,Amikacin.The resistant rate of Hospital infection strains was generally higher than that of community infection strains.The ESBLs （＋）rate of Escherichiacoli isolated from bloodstream infections of Urology Surgery wsa higher than that of other departments.Conclusion The drug resistance of Escherichiacoli in the bloodstream infections from hospital infection is higher than that from community infection.Using antibiotics rationally and strengthening the nosocomial infection surveillance of ICU and Surgery Ward are effective measures to control the bacterial drug resistance.