烧伤病房肠杆菌科细菌耐药性及其危险因素分析  

Analysis of drug resistance and risk factors of Enterobacteriaceae in burn units

作　　者：石苗苗[1] 赵冬梅[1] 汪强[1] 程君[1] 马泰[1] 徐元宏[2] 徐庆连[3] 李家斌[1] 

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥230022 [2]安徽医科大学第一附属医院检验科,合肥230022 [3]安徽医科大学第一附属医院烧伤科,合肥230022

出　　处：《中华烧伤杂志》2010年第3期199-201,共3页Chinese Journal of Burns

基　　金：国家自然科学基金（30772286）

摘　　要：目的 了解烧伤患者感染肠杆菌科细菌的耐药性及产超广谱β内酰胺酶（ESBL）菌感染的危险因素.方法 对2001年1月-2008年12月笔者医院烧伤病房细菌培养结果为肠杆菌科细菌的92例患者进行回顾性分析.分析其病原菌分布情况、耐药情况、产ESBL菌株检出率和耐药性,以及产ESBL菌引发医院感染的因素.数据行χ2检验.结果 共分离109株肠杆菌科细菌,其中阴沟肠杆菌38株占34.9%,大肠埃希菌25株占22.9%,肺炎克雷伯菌22株占20.2%,奇异变形杆菌13株占11.9%,其他肠杆菌科细菌11株占10.1%.常见肠杆菌科细菌除对亚胺培南的耐药率低于8.0%外,对其余抗菌药物均为中高度耐药.大肠埃希菌和肺炎克雷伯菌的ESBL检出率分别为44.0%、77.3%.产ESBL菌株对大多数抗菌药物的耐药率高于未产ESBL菌.单因素分析可见,患者住院时间大于20 d、第三代头孢菌素使用时间大于5 d、喹诺酮类药物使用时间大于7 d、外用抗菌药物使用时间大于5 d是产ESBL菌引发医院感染的危险因素,与未产ESBL菌比较,差异有统计学意义（χ2值分别为5.491、4.441、15.186、4.938,P值均小于0.05）.结论 笔者单位烧伤病房肠杆菌科细菌耐药情况严重,产酶率高,应加强监测,控制引起产ESBL菌感染的危险因素,减少其感染发生率.Objective To study the risk factors of infection of extended-spectrum beta-lactamases （ESBL） -producing strains and drug resistance of Enterobacteriaceae that infected burn patients. Methods A retrospective study was performed on clinical information of 92 patients with Enterobacteriaceae infection in our burn unit from January 2001 to December 2008. The distribution and drug resistance of Enterobacteriaceae , and the detection rate, drug resistance of ESBL-producing strains, and its risk factors of nosocomial infection were analyzed. Data were processed with Chi-square test. Results One hundred and nine strains of Enterobacteriaceae were isolated, with 38 （34.9%） strains of Enterobacter cloacae , 25 （22.9%） strains of Escherichia coli , 22 （20. 2%） strains of Klebsiella pneumoniae , 13 （11.9%） strains of Proteus mirabilis , and 11 （10. 1%） other strains of Enterobacteriaceae . Enterobacteriaceae were moderately or highly resistant to antibiotics except imipenem, resistance rate of which was less than 8. 0%. ESBL-producing strains accounted for 44. 0% in Escherichia coli , and 77. 3% in Klebsiella pneumoniae . Drug-resistance rate of ESBL-producing strains to antibiotics was obviously higher than that of non ESBL-producing strains. Length of hospital stay longer than 20 days, and use of the third-generation cephalosporin longer than 5 days, quinolone antibiotics longer than 7 days, and topical antibiotics longer than 5 days were the risk factors of nosocomial infection caused by ESBL-producing strains, comparing with non ESBL-producing strains, the difference was statistically significant （with χ2 value respectively 5.491 , 4.441, 15. 186, 4. 938 , P values all below 0. 05） . Conclusions Enterobacteriaceae strains in burn unit of our hospital are highly drug resistant, with high lactamase-producing rates, calling for intense monitor to control the risk factors that predispose the infection of ESBL-producing strains in order to lower the infection rate.

关 键 词：烧伤 细菌 抗药性 Β-内酰胺酶类 危险因素 

分 类 号：R446.5[医药卫生—诊断学]