产超广谱β-内酰胺酶细菌致社区感染与医院感染耐药性调查分析

Investigation and analysis on drug resistance to community infection and nosocomial infection caused by extended-spectrum β-lactamase producing bacteria

目的探讨产超广谱β-内酰胺酶细菌致社区感染与医院感染耐药性分析,为指导临床合理用药提供依据。方法收集2014年1月～2017年12月检验科细菌培养产ESBLs的大肠埃希菌、肺炎克雷伯菌、奇异变形菌以及产酸克雷伯菌的菌株,在剔除重复菌株后,进行细菌耐药谱调查,并判断是否为医院感染,同时分析社区感染与医院感染的耐药性差异。结果我院2014年1月～2017年12月共检出产ESBLs细菌共647例,社区感染598例,医院感染49例,在对我院社区感染与医院感染的产ESBLs大肠埃希菌耐药率的比较中,发现医院感染的产ESBLs大肠埃希菌对米诺环素、庆大霉素、丁胺卡那霉素、头孢哌酮、头孢西丁以及头孢他啶的耐药性要高于社区感染;医院感染的产ESBLs肺炎克雷伯菌对米诺环素、头孢哌酮、头孢西丁及头孢曲松的耐药性要高于社区感染,并且以上差异均具有统计学意义(P<0.05)。结论院感工作人员应了解医院感染与社区感染的耐药性差异,并将结果及时反馈给临床科室,为临床合理使用抗菌药物提供准确的参考。

Objective To investigate the drug resistance of extended-spectrum β-1actamase producing bacteria in com- munity infection and nosocomial infection, and to provide guidance for clinical rational drug use. Methods The strains of ESBLs-producing Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Klebsiella oxysporum were collect- ed from the bacterial cultures of the Clinical Laboratory from January 2014 to December 2017. After eliminating dupli- cate strains, an investigation of bacterial resistance patterns was conducted, and whether it was nosocomial infection was determined. At the same time, the differences in drug resistance between community infections and nosocomial in- fections were analyzed. Results A total of 647 ESBLs-producing bacteria were detected in our hospital from January 2014 to December 2017. There were 598 cases of community infection and 49 cases of nosocomial infections. In the comparison of drug resistance rates of ESBLs-producing Escherichia coli in community infection and nosocomial infec- tion in our hospital, it was found that ESBLs-producing E. coli in nosocomial infection were more resistant to minocy- cline, gentamycin, amikacin, cefoperazone, cefoxitin and ceftazidime than that in community infection; the ESBLs-pro- ducing Klebsiella pneumoniae in nosocomial infection was more resistant to minocycline, cefoperazone, cefoxitin, and ceftriaxone than that in community infection. The above differences were statistically significant（P〈0.05）. Conclusion The staff in nosocomial infection department should understand the difference in drug resistance between nosocomial infection and community infection. The results should be sent back to the clinical departments in a timely manner, so as to provide an accurate reference for the rational use of antimicrobial drugs in clinical practice.