大肠埃希菌碳青霉烯异质性耐药分析及流行病学调查

Epidemiology and heterogeneous drug resistance of Escherichia coli

目的观察碳青霉烯异质性耐药大肠埃希菌(carbapenems heteroresistant Escherichia coli,CHEC)的流行病学特征,探讨大肠埃希菌异质性耐药菌感染的危险因素,为临床合理应用抗菌药物提供理论依据。方法收集临床标本分离的大肠埃希菌株,进行β-超广谱内酰胺酶(ESBLs)检测、典型CHEC检测、菌谱分析(PAP),同时对耐药谱进行分析,确证大肠埃烯菌碳青霉烯异质性耐药的独立危险因素。结果在200株大肠埃希菌中,主要分离自血液、尿液和痰液,检出率分别占29.5%、16.5%和15.0%。该菌对美罗培南、厄他培南和亚胺培南的异质性耐药率分别为7.0%、17.5%和20.5%。细菌产ESBLs、外科病区、先前使用过抗生素和侵袭性医疗操作是CHEC感染的主要危险因素(P<0.05)。结论大肠埃希菌中碳青霉烯异质性耐药现象非常严重,特别是细菌产ESBLs、外科病区、抗生素使用和侵袭性医疗操作与碳青霉烯异质性耐药有关。因此,临床应合理使用抗菌药物,规范侵袭性医疗操作,避免院内感染的暴发流行。

Objective To investigate the epidemiological characteristics of carbapenenems heteroresistant Escherichia coli （CHEC） and the risk factors of infections, so as to provides theoretical basis for the rational application of anti-microbial agents. Methods The Escherichia strains isolated from clinical specimens were collected. The extended - spectrumlactamase （ESBL） -producing isolates was tested. PAP assay was performed. The drug resistance spectrum was analyzed so as to confirm the independent risk factors for the heterogeneity resistance of E. coli. Results The 200 strains of Escherichia coil were mainly separated from blood, urine and sputum, and the detection rates were 29. 5% , 16. 5% and 15.0% , respectively. The rates of resistant heterogeneity were 6. 0% to meropenem （ MEM）, 20. 5% to ertapenem （ETP） and 29. 0% to imipenem （IMP）. The major risk factors were production of extendedspectrumbeta - lactamases （ESBLs） , the surgery department, previous antibiotic use and invasive operations （P 〈 0. 05 ）. Conclusion The carbapenems heteroresistant heterogeneity in Escheriehia coli is very serious. In particular, ESBLs, surgical ward, antibiotic use and invasive medical operations are related to the heterogeneity of carbon penicilliene.