碳青霉烯类耐药大肠杆菌尿路感染的危险因素探讨

Risk factors of carbapenem-resistant Escherichia coli urinary tract infections

目的探讨碳青霉烯类耐药大肠埃希菌(CREco)的耐药性及患者发生CREco尿路感染的危险因素。方法收集2015年1月—2017年12月在天津医科大学第二医院住院期间发生尿路感染,且尿培养结果为大肠埃希菌的患者资料共120例。采用病例对照研究方法分2组,病例组为感染CREco的患者24例,在出现CREco尿路感染的科室内按照性别及年龄(±5岁范围内)匹配的原则选取同时期发生碳青霉烯类敏感大肠埃希菌(CSEco)尿路感染患者作为对照,病例组与对照组按照1∶4比例匹配。比较2组的致病菌对18种抗菌药物的耐药性。探讨住院患者发生CREco尿路感染的危险因素。结果本院住院患者感染的CREco对氨苄西林等12种抗菌药物均表现出很强的耐药性,耐药率均高于70%;对除氨苄西林、庆大霉素、复方新诺明及替加环素外,其他14种抗菌药物的耐药率明显高于CSEco组(均P<0.05)。多因素分析结果显示,留置导尿管(OR=5.719,95%CI:2.084～15.697,P<0.01)和检出前住院时间长(OR=9.325,95%CI:1.962～44.330,P<0.01)是住院患者发生CREco尿路感染的独立危险因素。结论住院患者尿路感染的CREco耐药形势严峻,患者留置导尿管时应严格遵守标准化操作及临床指征,尽量缩短其住院时间,减少医院环境下的暴露,降低CREco所致尿路感染的风险。

Objective To investigate the drug resistance of carbapenem resistant Escherichia coli(CREco),and the risk factors of carbapenem-resistant CREco urinary tract infection.Methods Data of120cases with urinary tract infection occurred in the second hospital of Tianjin Medical University from January2015to December2017were collected,and the results of those urine cultures were Escherichia coli.A case-control study was conducted,and24patients with CREco infection were divided into the case group.The controls were selected among patients with carbapenem sensitive CREco infection in the same ward at the same time and were matched with CREco cases for gender and age.The number of control patients was four times than that of case group.The resistance of pathogenic bacteria to18kinds of antimicrobial agents were compared between the two groups.The risk factors of CREco urinary tract infection in the inpatients in our hospital were investigated.Results Patients with CREco infection showed strong resistance to ampicillin and other11antimicrobial agents,and the drug resistance rate was higher than70%.The drug resistance rates of14other antimicrobial agents except ampicillin,gentamicin,compound sulfamide and tigecycline were significantly higher than those in CSEco group(P<0.05).Multivariate regression analysis showed that patients with indwelling catheters(OR=5.719,95%CI:2.084-15.697,P<0.01)and the longer hospitalization time before detection(OR=9.325,95%CI:1.962-44.330,P<0.01)were both the independent risk factors of CREco urinary tract infection in inpatients.Conclusion The CREco resistance of urinary tract infection in inpatients is severe.Indwelling catheters should be strictly observed the standardized operation and clinical indications.It is important to short the time of hospitalization and decrease the exposure in the hospital environment,which may help to reduce the risk of urinary tract infection caused by CREco.