产超广谱β内酰胺酶的大肠杆菌同源性分析及护理防控建议

Homology of extended-spectrumβ-lactamases(ESBLs)-producing Escherichia coli and nursing prevention

目的调查产超广谱β内酰胺酶(ESBLs)的大肠杆菌的流行情况及是否存在交叉感染,为进一步采取有效的护理防控提供参考。方法将210例患者临床分离的大肠杆菌运用ESBLs表型确证试验确定产ESBLs的大肠杆菌的流行率和科室分布;运用基因外重复回文序列聚合酶链反应对产ESBLs大肠杆菌分布最广泛的科室(泌尿外科)的临床分离株进行同源性分析。结果产ESBLs的大肠杆菌共122株(流行率58.1%)、泌尿外科24株(流行率68.6%);产ESBLs的大肠杆菌主要分布在泌尿外科(19.7%)、胰腺外科(7.4%)、神经外科(6.6%);泌尿外科检出24株产ESBLs的大肠杆菌标本22例来自于尿液、1例来自于血液、1例来自于咽喉分泌物;24株产ESBLs的大肠杆菌同源性分析结果显示,在泌尿外科共有10个亚型的流行株,以E2(6株克隆株)、E5(4株克隆株)亚型最为流行。结论产ESBLs的大肠杆菌的流行率较高,泌尿外科感染较为严重。应关注与留取尿标本密切相关的护理操作各环节及留置尿管护理等操作,制定有效的护理防控措施,预防产ESBLs大肠杆菌的暴发流行。

Objective To investigate the prevalence of ESBLs-producing Escherichia coli and to explore whether cross infection is de- veloped or not. Methods Escherichia coli were isolated from 210 patients and ESBLs phenotype testing was employed to determine the prevalence and distribution of ESBLs-producing Eseheriehia coli. The clinical isolates of ESBLs producing Escherichia coil in department of urology were used for homology analysis by using repetitive extragenic palindromic polymerase chain reaction. Re- sults From the 210 patients, 122 （58.1%） isolates were ESBLs producing strains, and 24 of the isolates were from department of urology （68.60% ）. ESBLs-producing Escherichia coli were mainly presented in department of urology（19.7 %）, department of pan- creatic surgery（7.4%）, and department of neurosurgery（6.6%）. Of the 24 ESBLs-producing isolates from department of urology, 22 were obtained from urine, 1 from blood, and 1 from throat secretions. Homology analysis results revealed that 10 subtypes were prevalent in department of urology, with E2（6 clones） and E5 （4 clones） being the most prevalent. Conclusion The present study indicates a high prevalence of ESBLs-producing Escherichia coli and a serious situation of cross infection in department of urology. We should pay more attention to collecting urine specimens and to indwelling urinary catheter care, and conduct effective measures to prevent outbreak and spread of ESBLs-producing Escherichia coll.