儿童社区获得性与医院获得性产ESBLs大肠埃希菌耐药性与抗菌药物分析

Analysis of drug resistance and antimicrobial agents of community-acquired and hospital-acquired ESBLs producing Escherichia coli in children

目的了解儿童社区获得性与医院获得性产ESBLs大肠埃希菌引起感染的耐药特征,为临床经验性合理优化使用抗菌药物提供依据。方法回顾性分析2017~2019年医院儿科住院病区送检的临床标本分离产ESBLs大肠埃希菌,并对社区获得性与医院获得性产ESBLs大肠埃希菌感染的病例进行耐药性统计分析。标本有血液、深静脉插管管尖、中段尿、深部痰、肺泡灌洗液和伤口分泌物等。结果2017~2019年儿科住院病区检出大肠埃希菌737株,其中产ESBLs 674株;非产ESBLs 63株;院感率为9.35%。结论非产ESBLs感染中轻中度感染可选用酶抑制复合制剂,重度感染需选用或联用碳青霉烯类;产ESBLs感染中轻中度可按药敏试验选择头孢他啶、头霉素类或派拉西林/他唑巴坦作为一线用药。合理优化使用抗菌药物,预防耐药菌株的产生,加强医院感染管理,可以有效预防和控制MDRO在医院的传播。

Objective To investigate the drug resistance characteristics of community-acquired and hospital-acquired ESBLs producing Escherichia coli(ESBLs)in children,so as to provide the basis for clinical experience and rational use of antibiotics.Methods The clinical specimens of ESBLs producing Escherichia coli from the pediatric inpatient area of a hospital from 2017 to 2019 were retrospectively analyzed,and the drug resistance of community-acquired and hospital-acquired ESBLs producing Escherichia coli infections were statistically analyzed.Results From 2017 to 2019,737 strains of Escherichia coli were detected in pediatric wards,among which 674 strains were ESBLs producing Escherichia coli.Non-producing ESBLs 63 strains;The hospital awareness rate was 9.35%.Conclusion Enzyme inhibition complex can be used for mild and moderate infection of non-producing ESBLs and carbapenems should be used for severe infection.Ceftazidime,cephalomycin,or peracillin/tazobactam were selected as first-line drugs according to drug sensitivity test for mild and moderate ESBLs infection.Reasonable optimization of the use of antibacterial drugs,to prevent the emergence of drug-resistant strains,strengthen the management of hospital infection,can effectively prevent and control the transmission of MDRO in the hospital.