2014—2019年某三甲医院大肠埃希菌临床特征及危险因素分析

Clinical Analysis of the Characteristics and Risk Factors of Escherichia coli in a third-level first-class hospital from 2014-2019

目的 探讨某三甲医院大肠埃希菌的临床分布和耐药性分析,并对其可能存在的危险因素进行分析,为该院大肠埃希菌感染的预防和患者感染治疗提供临床依据。方法 收集2014—2019年某三甲医院临床分离的大肠埃希菌感染病例共629例,对其资料进行回顾性分析。使用Logistic回归分析产超广谱β内酰胺酶(ESBLs)大肠埃希菌感染的独立危险因素。结果肠埃希菌主要分布在普通外科(131,20.83%)、骨科(90,14.31%)和泌尿外科(89,14.15%)。标本来源主要分布在尿液(177,28.14%)、伤口分泌物(130,20.67%)和脓液(95,15.10%)。大肠埃希菌对一代二代头孢菌素类耐药率均大于90%,单环β-内酰胺类、三代头孢菌素类部分耐药,大肠埃希菌对左氧氟沙星耐药率变化有统计学意义(P<0.05);产ESBLs大肠埃希菌单因素分析感染病例中性别、肠外营养、留置尿管、动静脉置管、肿瘤患者、抗菌药物联合使用和手术史因素是主要影响因素(P均<0.05)。Logistic多因素回归分析,结果 显示留置尿管、抗菌药物联用和手术史是产ESBLs大肠埃希菌感染的危险因素(P均<0.05)。结论 该院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,临床治疗应根据药敏试验结果合理选择敏感药物,并根据调查结果采取有针对性的预防措施,以降低医院耐药菌感染的发生。

Objective To explore the clinical distribution and resistance analysis of Escherichia coli in a third A hospital,and to analyze the possible risk factors,to provide a clinical basis for the prevention of Escherichia coli infection and the treatment of patient infection in the hospital.Methods A total of 629 cases of Escherichia coli infection clinically isolated from a third A hospital from 2014 to 2019 were collected,and their data were analyzed retrospectively.Independent risk factors for E.coli were screened using Logistic regression analysis to univariate and multivariate infection.Results Escherichia coli was mainly distributed in general surgery(131,20.83%),orthopedics(90,14.31%),and urology(89,14.15%).The sources of the specimens were found mainly in urine(177,28.14%),wound secretions(130,20.67%),and fester(95,15.10%).E.coli resistance was greater than 90%,mono-ceramide,and partial resistance to levofloxacin(P<0.05);and extended-spectrumβ-lactamase E.coli gender,parenteral nutrition,indwelling catheter,arteriovenous catheterization,tumor patients,antimicrobial combination and surgical history were the main risk factors(all P<0.05).In the logistic multivariate regression analysis,the results showed that the indwelling catheter,antimicrobial combination,and surgical history were risk factors for extended-spectrumβ-lactamase E.coli infection,with statistically significant differences(P<0.05).Conclusion The drug resistance of Escherichia coli is serious,and various factors can increase the risk of infection.clinicians should take comprehensive consideration in the diagnosis and treatment process strong hospital infection management,clinical treatment should reasonably choose sensitive drugs according to the drug-sensitive test results,and take targeted preventive measures according to the investigation results to reduce the occurrence of drug-resistant bacteria infection in the hospital.