某医院2017-2019年大肠埃希菌的临床分布及耐药性分析

Clinical Distribution and Drug Resistance Analysis of Escherichia Coli in a Hospital From 2017 to 2019

目的:了解3440株大肠埃希菌的临床分布以及耐药情况,以指导临床抗生素的合理应用,最大程度地避免诱导超级细菌的出现及院内感染的发生。方法:选用某三甲医院2017年1月1日-2019年12月31日送检标本中分离出的大肠埃希菌3440株,应用VITEK-2鉴定仪进行细菌鉴定,采用K-B纸片法进行药敏分析,运用WHONET5.6软件进行数据统计。结果:分离的3440株大肠埃希菌,主要标本来源为尿液1734株(50.4%),主要分布于普外科596株(17.3%)。3440例大肠埃希菌株中,产ESBLs大肠埃希菌1781株(51.8%),主要来源于痰液1044株(58.6%),主要分布在泌尿外科801株(45.0%),对氨苄西林、头孢唑啉、头孢呋辛、头孢曲松耐药率达90%以上。耐碳青霉烯类大肠埃希菌113株,痰液中检出46株(40.7%),主要分布在呼吸内科28株(24.8%)。3年来,耐碳青霉烯类大肠埃希菌的比率逐年明显上升,分别为0.7%、2.7%、5.7%,且只对少数几种抗生素(阿米卡星、庆大霉素、复方新诺明)敏感。结论:该院大肠埃希菌检出率及多重耐药菌株占比逐年增加,应进一步强化抗生素临床应用的监测,增强操作诊疗的规范性,减少耐药菌株的出现,避免院内感染的发生。

Objective To understand the clinical distribution and drug resistance of 3440 strains of Escherichia coli,so as to guide the rational application of clinical antibiotics and avoid inducing the emergence of superbacteria and nosocomial infec⁃tions to the greatest extent.Methods 3440 strains of escherichia coli isolated from the specimens sent to a third-grade hos⁃pital from January 1,2017 to December 31,2019 were selected for bacterial identification by vitek-2 identification instru⁃ment,drug sensitivity analysis was performed by k-b disk method,and data statistics were performed by WHONET5.6 soft⁃ware.Results The 3440 strains of Escherichia coli isolated were mainly from urine specimens 1734(50.4%),and 596(17.3%)strains were distributed in general surgery.Among the 3440 strains,1781 strains(51.8%)were ESBLs produ⁃cing E.coli,1044 strains(58.6%)were mainly from sputum,801 strains(45.0%)were mainly distributed in urology de⁃partment,and more than 90%of them were resistant to ampicillin,cefazolin,cefuroxime and ceftriaxone.Among 113 strains of carbapenem resistant Escherichia coli,46 strains(40.7%)were detected in sputum,and 28 strains(24.8%)were mainly distributed in respiratory department.In the past three years,the ratio of carbapenem-resistant Escherichia coli increased significantly year by year,which were 0.7%,2.7%and 5.7,respectively.The strains were sensitive to only a few antibiotics(amikacin,gentamicin,cotrimoxazole).Conclusion The detection rate of Escherichia coli and the proportion of multiple drug resistant strains increased year by year.We should further strengthen the monitoring of clinical application of antibiotics,strengthen the standardization of operation diagnosis and treatment,reduce the emergence of drug-resistant strains,and avoid the occurrence of nosocomial infection.