大肠埃希菌临床分布及耐药性分析

Clinical distribition and drug resistance of Escherichia coli

目的了解医院大肠埃希菌临床分布、标本类型、不同科室及不同年龄耐药情况,为临床合理使用抗菌药物提供依据。方法收集亳州市人民医院2011―2018年门诊与住院病人送检10827株大肠埃希菌,回顾性分析其耐药性变化、科室分布及标本来源。结果8年间大肠埃希菌分离率为3.92%,分离率呈下降趋势(P<0.05)。共收集非重复菌株9302株,其中产超广谱β-内酰胺酶(ESBLs)大肠埃希菌5547株,占59.63%。标本来源主要为尿液,占26.01%;科室分布以普外科最多,占27.77%。药敏分析显示,大肠埃希菌对头孢曲松及庆大霉素的耐药性有所下降(P<0.05)。产ESBLs菌株对大多数抗菌耐药率明显高于非ESBLs菌株(P<0.05)。痰液标本分离菌对氨曲南耐药率高于其他标本的分离菌(P<0.05)。呼吸内科分离菌耐药率高于其他科室的分离菌。老年病人分离菌耐药率高于其他年龄的分离菌。结论大肠埃希菌耐药形势严峻,且不同科室、不同标本、不同年龄段及不同时间耐药率有所差异。临床医师需结合本单位、本科室耐药情况,合理选用抗菌药物。同时需加强大肠埃希菌监测及抗菌药物管理,减少细菌耐药的出现。

Objective To know about clinical distribution,specimen types of Escherichia coli,and its drug resistance in different departments and age groups,so as to provide reference for clinical rational use of antibiotics.Methods A total of 10827 strains of Escherichia coli collected from outpatients and inpatients of Bozhou People’s Hospital from 2011 to 2018 were adopted for a retrospective analysis of its drug resistance,clinical distribution,and specimen source.Results The isolation rate of Escherichia coli was 3.92%in 8 years,and the separation rate showed a downward trend(P<0.05).A total of 9302 strains of nonrepetitive strains were collected,including 5547(59.63%)strains of extended-spectrumβ-lactamase(ESBLs)Escherichia coli.The Escherichia coli were mainly isolated from urine,accounting for 26.01%.And they were mainly isolated from Department of General Surgery,accounting for 27.77%.Susceptibility testing results showed that the resistance rates of Escherichia coli to ceftriaxone and gentamicin were decreased(P<0.05).The resistance rate of ESBLs-producing strains to most antibiotics was significantly higher than that of non-ESBLs-producing strains(P<0.05).The strains isolated from sputum samples had higher resistance rate to aztreonam than the strains from other specimens(P<0.05).The Escherichia coli strains isolated from Department of Respiratory Medicine showed significantly higher resistance rates than those from other departments.The Escherichia coli isolated from the elderly patients showed higher resistance rate than that from other age groups.ConclusionS The drug resistance of Escherichia coli is serious,and the drug resistance rates are different among different departments,different specimens,different age groups and different times.In order to select antibiotics reasonably,clinicians should take the status quo of drug resistance of the hospital and department they work in into consideration.Meanwhile,the surveillance of Escherichia coli and the management of antibiotics should be strengthened to reduce the occurrence of bacterial resistance.