大肠埃希菌临床分布和耐药性变化

Analysis of changes in clinical distribution and antimicrobial resistance of Escherichia coli

目的:了解大肠埃希菌临床分布以及耐药性,为合理使用抗生素提供科学依据。方法:对2009-2015年间分离的大肠埃希菌的药物敏感试验结果进行回顾性分析,数据采用WHONET5.6软件和SPSS 13.0统计软件进行分析。结果:7年共分离大肠埃希菌3 382株,主要分离自尿液、痰液、分泌物,分别为30.4%、28.6%、13.8%;其科室分布主要来源于重症监护室、肾内科、产科,分别为16.9%、11.8%、8.2%、;大肠埃希菌占分离革兰阴性杆菌的比例在6.9%~15.1%;7年间产ESBLs大肠埃希菌的检出率在48.9%;发现亚胺培南耐药的大肠埃希菌,分离率为7.8%;产ESBLs大肠埃希菌对大部分抗菌药物耐药率明显高于非产ESBLs大肠埃希菌。结论:加强大肠埃希菌细菌耐药监测,了解其耐药变迁,指导临床合理用药,防止耐药菌株,尤其是对碳青霉烯类耐药的大肠埃希菌的传播。

Objective：To understand the changes of clinical distribution and antimicrobial resistance of Esche- richia coil, so as to provide scientific basis for reasonable clinical use of antibiotics. Method： Microbial sensitivity tests of E. coli strains collected from the patients from 2009 to 2015 were reviewed. WHONET 5. 6 and SPSS 13.0 were applied for analysis. Result：Totally 3 382 strains of E. coli were isolated and identified. Most of these strains were collected from urine （30.4%）, sputum （28. 6%）and secretions （13.8%）. The top three depart- ments where strains mainly distributed were Intensive Care Unit （ICU） （16.9 %）, Urology department （11.8 %） and Obstetrical department （8.2%）. The ratio of Escherichia coil in Gram-negative bacilli was from 6.9% to15.1%. The overage detection rate of extended spectrum beta-lactamase （ESBLs） producing Escherichia coil was 48.90% in the 7 years. Imipenem-resistant strain was found （7.8%） in Escherichia coil. The resistance of ES- BLs positive Escherichia coil to most antibiotics was much higher than that of ESBLs negative Escherichia coil. Conclusion：Clinicians should enhance the monitoring of resistance of Escherichia coil, and understand its changes to guide clinical rational antibiotic use and prevent cross-strain, especial Cabapenem-resistantstrain transmission.