胆道肠球菌感染的相关危险因素与耐药性比较分析

Comparative analysis of hazard risk factors and drug resistance of Enterococcus infection in biliary tract

目的探讨胆道肠球菌感染的相关危险因素与耐药特征,为临床降低感染率和合理治疗提供依据。方法回顾性分析2014年1月-2017年6月胆道肠球菌感染患者的临床资料。结果调查表明胆道手术史、胆结石、胰腺癌、既往ERCP操作和入院时APACHEⅡ评分是胆道肠球菌感染的主要危险因素,主要病原菌为屎肠球菌和粪肠球菌,分别占70.8%和26.3%,除氯霉素、四环素和喹奴普汀/达福普汀外,屎肠球菌对大多数抗菌药物的耐药率远高于粪肠球菌,两者对利奈唑胺、万古霉素和替考拉宁的耐药率均<10%,差异无统计学意义(P>0.05)。结论针对胆道肠球菌感染的危险因素进行有效干预,可降低和控制感染的发生,屎肠球菌和粪肠球菌对抗菌药物的耐药性存在较大差异,肠球菌对利奈唑胺、万古霉素和替考拉宁仍保持低耐药性,临床应加强对耐药菌株的监测和预防控制。

Objective To investigate the risk factors and drug resistance characteristics of Enterococcus infection in biliary tract,so as to provide basis for reducing infection rate and reasonable treatment. Methods The clinical data of patients with Enterococcus infection from January 2014 to June 2017 were retrospectively analyzed. Results The investigation showed that the history of biliary tract surgery,gallstone,pancreatic cancer,past ERCP operation and APACHE Ⅱ score were the major risk factors for Enterococcus infection,the main pathogens were Enterococcus faecium and Enterococcus faecalis,accounting for70. 8% and 26. 3% respectively,in addition to chloramphenicol,tetracycline and quinuprine/dalfopristin,the resistance rate of Enterococcus faecium to most antibiotics was much higher than that of Enterococcus faecalis,the resistance rates of both to linezolid,vancomycin and teicoplanin were less than 10%,and the differences were not statistically significant（ P 〉 0. 05）. Conclusion Effective intervention on the risk factors of Enterococcus infection in biliary tract can reduce and control the occurrence of infection,the resistances of Enterococcus faecalis and Enterococcus faecalis to antibiotics were different,and Enterococcus remain low resistance to linezolid,vancomycin and teicoplanin,so clinical surveillance and control of resistant strains should be strengthened.