我院产ESBLs大肠埃希菌的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of ESBLs-producing escherichia coli in our hospital

目的研究我院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌在临床各科室的分布及耐药情况,探讨其危险因素,为临床合理用药及预防提供依据。方法对2017年1月至2018年12月我院临床各类标本分离的大肠埃希菌进行鉴定及药敏分析,对影响产ESBLs大肠埃希菌感染的因素进行单因素和Logistic多元回归分析。结果共检出2800株大肠埃希菌,排前3位的标本类型分别为尿液(33.54%)、痰液(18.43%)、胆汁(14.79%),其中ESBLs阳性株1545株(55.18%),分离的大肠埃希菌株分布于27个科室,其中康复科最多(13.54%),其次为神经外科(含NICU)(11.79%)、泌尿外科(10.11%)等。耐药分析:对大肠埃希菌耐药率较高的为氨苄西林、头孢呋辛、头孢曲松、头孢唑啉、环丙沙星和左氧氟沙星,耐药率<10%的分别为哌拉西林/他唑巴坦、亚胺培南、呋喃妥因、替加环素等。产ESBLs大肠埃希菌感染的危险因素包括年龄、住院时间延长、入住ICU、糖尿病、实体肿瘤、呼吸系统疾病、肝胆疾病、胃肠疾病、脑血管疾病、低白蛋白血症、腹部手术史、细菌检出前4月侵入性操作(机械通气、肠外营养、导尿管、内置引流管、动静脉置管)、使用多种抗菌药物(≥3种)(P<0.05),产ESBLs大肠埃希菌感染的患者死亡率较非产ESBLs组高。对本组资料进行多因素分析发现,独立危险因素包括性别和住院时间。结论我院产ESBLs大肠埃希菌的耐药现象较严重,多种因素均可导致感染风险增加,临床医生在诊疗过程中需综合考虑,加强医院感染管理,减少耐药菌感染。

Objective To study the distribution and drug resistance of extended spectrum beta-lactamases(ESBLs)-producing escherichia coli in clinical departments of our hospital,to explore its risk factors,and to provide evidence for rational drug use and prevention.Methods Escherichia coli isolated from various clinical specimens in our hospital from January 2017 to December 2018 were identified and analyzed for drug susceptibility.And then the factors affecting ESBLs-producing escherichia coli infection were analyzed by univariate and Logistic multiple regression analysis.Results A total of 2800 strains of escherichia coli were detected.The top three specimen types were urine(33.54%),sputum(18.43%)and bile(14.79%).Among them,1,545 strains were ESBLs-positive(55.18%).The isolated escherichia coli strains were distributed in 27 departments,among which the rehabilitation department had the most(13.54%),followed by department of neurosurgery(including NICU)(11.79%),and department of urology(10.11%).Drug resistance analysis:The risk factors of ESBLs producing escherichia coli infection included age,prolonged hospital stay,ICU stay,diabetes mellitus,solid tumor,respiratory system disease,hepatobiliary disease,gastrointestinal disease,cerebrovascular disease,hypoalbuminemia,history of abdominal surgery,invasive operation 4 months before bacteria detection(mechanical ventilation,parenteral nutrition,catheter,internal drainage tube,arteriovenous catheter),multiple antibiotics(≥3)(P<0.05).The mortality rate of patients with ESBLs-producing escherichia coli was higher than that of the non-ESBLs-producing group.Multivariate analysis of the data in this group found that independent risk factors included gender and length of hospital stay.Conclusion The resistance of ESBLs-producing escherichia coli in our hospital is serious,and various factors can increase the risk of infection.Clinicians need to consider comprehensively in the process of diagnosis and treatment,strengthen hospital infection management and reduce drug-resistant bacteria infection.