尿路感染产ESBLs大肠埃希菌的耐药性及危险因素分析

Analysis of drug resistance and risk factors of ESBLs producing E. coli causing urinary tract infection

目的探讨尿路感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的耐药性及危险因素。方法收集分离自尿液中的大肠埃希菌346株,对产ESBLs和非产ESBLs大肠埃希菌进行耐药性比较,并采用Logistic回归分析产ESBLs菌株致尿路感染的危险因素。结果分离自尿液的大肠埃希菌产ESBLs率为60.4%(209/346)。产ESBLs菌株对大部分β-内酰胺类、氨基糖苷类、氟喹诺酮类、复方磺胺甲恶唑等抗菌药物的耐药性明显高于非产ESBLs菌株(P<0.05)。年龄(≥50岁)、基础疾病、住院天数≥10 d、留置导尿管、抗菌药物联用是产ESBLs大肠埃希菌的危险因素。结论产ESBLs菌株耐药性严重,临床在对尿路感染患者经验治疗前应根据患者实际情况进行危险因素的评估,并根据本院的细菌流行病学结果合理选用抗菌药物。

Objective To explore the drug resistance and risk factors of ESBLs- producing E. coli in urinary tract infection（ UTI）. Methods To collect 346 E. coli isolates,the drug resistance was compared between ESBLs- producing isolates and non- ESBLs- producing isolates,while Logistic regression analysis was adopted to investigate the clinical risk factors of UTI caused by ESBLs- producing isolates. Results ESBLs- producing rate of E. coli from sample of urinary tract infection was60. 4%（ 209 /346）. The antimicrobial resistance of ESBLs- producing isolates to almost all beta lactams,aminoglycosides,fluoroquinolones,compound sulfamethoxazole was significantly higher than the non- ESBLs- producing isolates（ P〈0. 05）. The elderly（ ≥50 years）,underlying disease,hospital stay over 10 days,indwelling catheter and combined antimicrobial agents were the risk factors of E. coli producing ESBLs. Conclusion The drug resistance of ESBLs- producing E. coli isolates are serious,risk factors assessment should be performed before the treatment on patients with UTI by experience,according to the reality. And make reasonable use of antibiotics according to the results of bacterial epidemiology.