肛周脓肿术后切口感染大肠埃希菌的危险因素及其耐药基因和毒力因子

Risk factors of incision infection with Escherichia coli after perianal abscess surgery and its drug resistance genes and virulence factors

目的 分析肛周脓肿术后切口感染大肠埃希菌的危险因素及其耐药基因和毒力因子。方法 选取2017年8月-2021年8月焦作市人民医院收治的肛周脓肿术后切口感染大肠埃希菌患者32例作为研究组,选取同期单纯肛周脓肿术后未发生感染患者32例作为对照组;比较患者临床一般资料,归纳肛周脓肿患者术后感染大肠埃希菌的危险因素;采用最低抑菌浓度分析细菌的耐药性,实时荧光定量聚合酶链式反应(PCR)检出大肠埃希菌耐药基因和毒力基因。结果 合并糖尿病(OR=1.765,P=0.004)、术后使用抗菌药物(OR=1.627,P=0.017)和抗菌疗程(OR=1.654,P=0.027)是肛周脓肿术后切口感染大肠埃希菌的危险因素;大肠埃希菌对氨苄西林(75.00%)、左氧氟沙星(71.88%)、哌拉西林(71.88%)耐药率较高,对亚胺培南和美罗培南最敏感;32株大肠埃希菌中毒力基因fimH检出率为90.63%,traT检出率93.75%,Einv检出率59.38%;耐药基因GyrA检出率为96.88%,GyrB检出率96.88%,blaTEM检出率93.75%;不同毒力因子和耐药基因检出率之间差异有统计学意义(P<0.05)。结论 肛周脓肿患者术后切口感染大肠埃希菌的危险因素较多,毒力基因的耐药基因种类较多,耐药形势严峻;临床可根据毒力基因和耐药基因采取合理预防措施,降低术后感染率。

OBJECTIVE To analyze the risk factors for postoperative perianal abscess incision infection with Escherichia coli and its drug resistance genes and virulence factors. METHODS A total of 32 patients with postoperative perianal abscess incision infection with Escherichia coli admitted to Jiaozuo People′s Hospital between Aug.2017 and Aug.2021 were selected as the study group, and 32 simple perianal abscess patients who did not have postoperative infection during the same period were selected as the control group.The general clinical data of patients were compared between the two groups, and the risk factors of postoperative infection with Escherichia coli infection in patients with perianal abscess were summarized.The drug resistance of bacteria was analyzed by the minimum inhibitory concentration, and the resistance genes and virulence genes of Escherichia coli were detected by real-time fluorescent quantitative polymerase chain reaction(PCR). RESULTS Comorbid Diabetes mellitus(OR=1.765, P=0.004), postoperative usage of antibiotics(OR=1.627, P=0.017) and course of antibiotics treatment(OR=1.654, P=0.027) were the risk factors for postoperative incision infection with Escherichia coli in perianal abscess.Escherichia coli had a high resistance rates to ampicillin(75.00%), levofloxacin(71.88%) and piperacillin(71.88%), and was the most sensitive to imipenem and meropenem.The detection rates of virulence genes in the 32 strains of Escherichia coli were 90.63% for fimH, 93.75% for traT, and 59.38% for Einv, and detection rates of drug resistance genes were 96.88% for GyrA, 96.88% for GyrB, and 93.75% for blaTEM.The differences in detection rate among patients with different virulence factors and resistance genes were statistically significant(P<0.05). CONCLUSION There were more risk factors for postoperative incision infection with Escherichia coli in patients with perianal abscess, more types resistance genes for virulence genes, and severe drug resistance.Clinically, reasonable prevention measures could be taken based on virulence genes and drug resistance genes to reduce incidence of postoperative infection.