产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的临床特点及感染的危险因素分析

Clinical distribution of extended-spectrum-β-lactamase-producing Escherichiacoli and Klebsiella pneumoniae and analysis of infection risk factors

目的分析该院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌临床分布、耐药性及危险因素,为预防和控制这些细菌的医院感染提供参考依据。方法收集该院2019年1-6月237例住院患者检出的非重复大肠埃希菌及肺炎克雷伯菌,采用BD-Phoenix-100系统进行菌种鉴定和药敏实验,根据是否产生ESBLs分为产ESBLs组和非产ESBLs组,对两组的临床特点进行统计分析,用χ^(2)检验和Logistic多因素回归分析产ESBLs菌株感染危险因素。结果2019年1-6月分离出大肠埃希菌173株,肺炎克雷伯菌64株,其中检出产ESBLs大肠埃希菌59株,产ESBLs肺炎克雷伯菌17株,构成比分别为34.1%,26.6%。产ESBLs菌株对除碳青霉烯类的大部分抗菌药物的耐药率普遍高于非产ESBLs菌株(P<0.05)。Logistic多因素回归分析显示,年龄≥60岁、低蛋白血症、第3代头孢菌素用药史是产ESBLs菌株感染的独立危险因素(P<0.05)。结论产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率较高,医院应根据危险因素对重点人群实施监测,合理应用抗菌药物,加强医院感染管理,有利于减少该菌感染的发生。

Objective To analyze the clinical distribution,drug resistance and infection risk factors of extended-spectrum-β-lactamase(ESBLs)-producing Escherichia coli and Klebsiella pneumoniae so as to provide reference for the prevention and control of nosocomial infection.Methods Non-repetitive Escherichia coli and Klebsiella pneumoniae were isolated from a total of 237 hospitalized patients from January 2019 to June 2019.The BD-Phoenix-100 system was employed for bacterial identification and antimicrobial susceptibility tests.Strains were divided into ESBLs producing group and non ESBLs producing group according to whether ESBLs were generated or not.The risk factors were analyzed by using chi-square and Logistic regression.Results Totally 173 strains of Escherichia coli and 63 strains of Klebsiellan pneumoniae were isolated from the submitted specimens from January 2019 to June 2019,59 strains of ESBLs-producing Escherichia coli and 17 strains of ESBLs-producing Klebsiellan pneumoniae were detected,with the proportion of 34.1%and 26.6%respectively.Nearly all ESBLs producing strains were susceptible to carbapenems,and the resistance rate of ESBLs producing strains to most antimicrobial agents was higher than that of non-producing ESBLs strains(P<0.05).Logistic regression analysis showed that age≥60 years,hypoproteinemia and previous use of the third generation cephalosporins were the independent risk factors of ESBLs producing strains infections(P<0.05).Conclusion The detection rate of ESBLs-producing Escherichia coli and Klebsiella pneumoniae is high.The hospital should monitor the key population according to the risk factors,apply antimicrobial agents reasonably and strengthen the management of nosocomial infection,which is helpful to reduce the incidence of ESBLs-producing strains infections.