泌尿外科患者尿路感染产ESBLs大肠埃希菌的危险因素及其耐药性分析

Risk Factors and Drug Resistance Analysis for ESBLs-producing E.coli Found in Urine Culture in Urology

目的:探讨本院泌尿外科患者尿培养中检出产ESBLs大肠埃希菌的危险因素及其耐药性情况,为减少该菌的感染及临床合理使用抗菌药物提供依据。方法:调查2016~2018年尿培养检出大肠埃希菌321例,应用单因素分析(t检验和χ2检验)及多因素Logistic回归分析产ESBLs大肠埃希菌感染的危险因素,并分析该菌的药敏情况。结果:多因素Logistic回归分析提示,院内感染(OR=5.902,95%CI=1.282~27.178)、反复尿路感染(OR=2.800,95%CI=1.235~6.349)、尿培养前15天内使用三代头孢类(OR=6.720,95%CI=1.924~23.480)、尿培养前15天至3月内使用二代头孢类(OR=4.088,95%CI=1.469~11.376)是感染产ESBLs大肠埃希菌的独立危险因素(P<0.05);在321例中,产ESBLs大肠埃希菌的检出率为53.0%,该菌对碳青霉烯类、阿米卡星、头霉素类、哌拉西林他唑巴坦、呋喃妥因仍保持较高的敏感性(>90%),耐药率超过75%的药物仅有氨苄西林。结论:规范医院对感染患者的管理,合理使用抗菌药物,对减少该菌感染具有重要意义。

Objective:To evaluate risk factors for ESBLs-producing Escherichia coli(E.coli)infection and drug resistance in urine culture of urology in our hospital,so as to provide scientific basis for reducing the incidence of ESBLs and rational use of antibiotics in clinic.Methods:By a case-control study,the data of 321 cases of infection caused by E.coli found in urine culture from 2016 to 2018 in urology were analyzed.Univariate and multivariate logistic analysis were used to examine the risk factors of E.coli infection.Drug resistances of the E.coli from infected patients were analyzed.Results:Multivariate logistic regression analysis revealed that nosocomial infection(OR=5.902,95%CI:1.282~27.178),recurrent urinary tract infection(OR=2.800,95%CI:1.235~6.349),use of third-generation cephalosporins 15 days before urine culture(OR=6.720,95%CI:1.924~23.480)and use of second-generation cephalosporins 15 days to 3 months before urine culture(OR=4.088,95%CI:1.469~11.376)were independent risk factors for ESBLs-producing E.coli infection.Of the 321 infected patients,53.0%were detected positive of ESBLs-producing E.coli.These E.coli remained highly sensitive to carbapenems,amikacin,cefotetan,piperacillin-tazobactam and furantoin(>90%).Ampicillin was the only drug with a resistance rate of more than 75%.Conclusion:Standardize hospital management of infected patients and rational use of antibiotics are of great significance to reduce the incidence of ESBLs-producing E.coli.