血流感染患者产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌耐药性及危险因素分析

Antibiotic resistance and risk factor analysis of bloodstream infections caused by extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae

目的分析血流感染患者产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的耐药性,探讨导致其感染的危险因素及相关预后,为临床治疗和预防提供依据。方法回顾性分析2014年1月—2018年12月天津市第五中心医院住院的214例产ESBLs大肠埃希菌和肺炎克雷伯菌血流感染患者的临床资料。结果共收集到菌株214株,其中大肠埃希菌157株,肺炎克雷伯菌57株,产ESBLs菌株的检出率分别为52.2%和24.6%。产ESBLs菌株对青霉素、头孢菌素、氨基糖苷类和喹诺酮类抗菌药物的耐药率显著高于非产ESBLs菌株。多因素回归分析显示,感染前30d使用头孢菌素是产ESBLs菌株感染的危险因素,合并肿瘤性疾病、慢性肝脏疾病、血红蛋白<100g/L、入住ICU是大肠埃希菌和肺炎克雷伯菌血流感染患者死亡的独立危险因素。结论产ESBLs大肠埃希菌和肺炎克雷伯菌耐药形势严峻,感染前30d使用头孢菌素增加产ESBLs菌株感染的风险,合并肿瘤性疾病、慢性肝脏疾病、血红蛋白<100g/L、入住ICU提示大肠埃希菌和肺炎克雷伯菌血流感染患者预后不佳。

Abastract Objective To investigate the antibiotic resistance, particularly the risk factors and prognosis of bloodstream infections caused by extended-spectrum beta-lactamases(ESBLs)-producing Escherichia coli and Klebsiella pneumoniae, and provide evidence for clinical treatment and prevention of bloodstream infections. Methods Totally 214 patients from January 2014 to December 2018 in the 5 th Central Hospital of Tianjin were analyzed. The clinical data and outcome were collected and reviewed retrospectively. Results A total of 214 pathogenic strains were detected, of which 157 were Escherichia coli and 57 were Klebsiella pneumoniae. The proportion of ESBLs-producing strains in Escherichia coli was 52.2%, and the proportion of ESBLs-producing strains in Klebsiella pneumonia was 24.6%. ESBLs-producing strains showed higher resistance rates against penicillins, cephalosporins, aminoglycosides, and quinolones than non ESBLs-producing strains. Multivariable regression analysis indicated that the use of cephalosporins in recent 30 days was the risk factor for ESBLs-producing strains infections. Tumor, chronic liver disease, HGB<100 g/L and ICU admission were the independent risk factors for the death of bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae. Conclusion The surveillance data indicated that the resistance situation of ESBLs-producing Escherichia coli and Klebsiella pneumoniae infections was fairly severe. These data suggested that the use of cephalosporins in recent 30 days increased the risk of ESBLsproducing strains infections. The patients infected by Escherichia coli and Klebsiella pneumoniae, who had tumor or chronic liver disease, whose HGB was less than 100 g/L, or admitted to ICU, had a poor prognosis.