急诊科大肠埃希菌耐药性及多重耐药大肠埃希菌感染危险因素的研究

Study on the drug resistance of escherichia coli and risk factors of multidrug resistant escherichia coli infection which come from emergency department

目的：探讨急诊科大肠埃希菌（EC）的耐药性及感染多重耐药大肠埃希菌（MREC）的危险因素。方法：收集2014-01-2015-06EC 208株,分别采用全自动微生物分析仪和琼脂稀释法鉴定细菌和检测药物敏感性。根据药物敏感性结果,分别把二级医院EC分为耐药菌组（A组）和多重耐药菌组（B组）,而三级医院则分为耐药菌组（C组）和多重耐药菌组（D组）,统计EC的药物敏感性结果、感染部位和MREC感染危险因素,采用χ-2检验和多因素Logistic回归分析数据。结果：MREC在二、三级医院中分别占EC的70.11%（61/87）和62.81%（76/121）。头孢他啶、环丙沙星、呋喃妥因在B组耐药率明显高于A组,而头孢他啶、阿米卡星、复方新诺明在D组耐药率明显高于C组（P〈0.05）。B组泌尿道系统感染明显多于A组,而D组血液系统感染明显多于C组（P〈0.05）。进EICU≥7d、侵入性操作和住院≥15d是二级医院急诊科患者感染MREC的独立危险因素。而三级医院的独立危险因素则是进EICU≥7d、侵入性操作和卧床≥10d。结论：急诊科EC的耐药形势严峻,其耐药性、感染部位和MREC感染危险因素在二、三级医院中有相同之处亦有不同之处。

Objective：Investigate the drug resistance of escherichia coli（EC）and risk factors of multidrug resistant escherichia coli（MREC）infection which come from emergency department.Method：No repeat 208 strains of EC were collected From January 2014 to June 2015.The EC which come from the grade 2hospital were defined as group A（drug resistance bacteria group）and group B（multidrug resistant bacteria group）,and the EC which come from the grade 3hospital were defined as group C（drug resistance bacteria group）and group D（multidrug resistant bacteria group）according to the result of drug susceptibility.The automated microbiology analyzer and agar dilution method were used to bacteria identification and detections of drug sensitivity.The results of drug susceptibility,infection system and risk factors of MREC infection were measured,and the chi-square test and multifactor logistic regression analysis were used by data analysis.Result：The MREC were 70.11%（61/87）and62.81%（76/121）in the grade 2hospital and grade 3hospital.The drug-resistance rates of group B to ceftazidime,Ciprofloxacin,nitrofurantoin were all significantly higher than those of group A,while drug-resistance rates of group D to ceftazidime,amikacin,bactrim were all significantly higher than those of group C（all P〈0.05）.Urinary tract infection in the group B was significantly more than those of group A,and the hematological system infection in the group D was significantly more than those of group C（all P〈0.05）.The independent risk factors of MREC infection were ＂stay EICU≥7days＂, ＂invasive procedures＂ and ＂ hospitalization≥15days＂ in grade 2hospital,while were ＂stay EICU ≥7days＂, ＂invasive procedures＂ and ＂lying in bed≥10days＂ in grade 3hospital.Conclusion：The drug-resistance situation of EC is serious in the emergency department in western Guangdong province,and there are both similarities and differences in resistance characteristics,infection system and risk factors of MREC infection between the emergency department of grade 2hospital and the emergency department of grade 3hospital.