产超广谱β－内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性及其所致血流感染的危险因素  

Antibiotic resistance of ESBLs-producing Escherichia coli and Klebsiella pneumoniae isolates and risk factors for bloodstream infections

作　　者：丁月平[1,2] 陆军[2] 俞云松[1] 周志慧[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院感染科,杭州310016 [2]浙江中医药大学附属第二医院ICU

出　　处：《中华临床感染病杂志》2015年第2期102-107,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金（81471986）

摘　　要：目的探讨产超广谱β－内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌对抗菌药物的耐药性及其导致血流感染的危险因素。方法连续收集2009年9月至2014年6月浙江中医药大学附属第二医院血培养大肠埃希菌和肺炎克雷伯菌阳性的131例患者的相关资料。所有菌株经Vitek2全自动微生物分析仪进行菌种鉴定及药敏试验，并采用纸片确证扩散法检测菌株是否产ESBLs。采用Logistic回归分析法研究产ESBLs菌株致血流感染的危险因素。结果 131例患者中，产ESBLs菌株感染65例，非产ESBLs菌株感染66例。产ESBLs菌株对大部分抗菌药物的耐药率明显高于非产ESBLs菌株，对青霉素、氨曲南及第三、四代头孢菌素的耐药率均〉50％；产ESBLs大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物和哌拉西林／他唑巴坦的耐药率分别是0～2．0％、2．3％和0～14．3％、26．7％。单因素分析显示，近3个月内使用头孢菌素类药物（χ^2=18．322，P〈0．01）、有产ESBLs菌株感染史（χ^2=14．610，P〈0．01）、近3个月内留置导尿管（χ^2=13．016，P〈0．01）、近3个月内医疗机构入住史（χ^2=11．269，P〈0．01）、近3个月内使用喹诺酮类药物（χ^2=10．638，P〈0．01）、医院获得性感染（χ^2=8．205，P〈0．01）、近3个月内留置深静脉导管或经外周静脉置入中心静脉导管（PICC）（χ^2=4．817，P〈0．05）以及近3个月内使用糖皮质激素（χ^2=4．265，P〈0．05）的患者在产ESBLs组中的比例明显高于非产ESBLs组。多因素Logistic回归分析发现，近3个月内使用喹诺酮类药物（OR=6．851，P〈0．01）、有产ESBLs菌株感染史（OR=6．344，P〈0．01）、近3个月内使用头孢菌素类药物（OR=3．719，P〈0．01）以及近3个月内留置导尿管（OR=3．180，P〈0．05）是造成产ESBLs大肠埃希菌和肺炎克雷伯菌血流感染的独立危险因素。结论产ESBLs大�Objective To investigate the antibiotic resistance of extended-spectrum-β-lactamases （ESBLs） -producing Escherichia coli （ E. coli ） and KlebsieUa pneumoniae （ K. pneumoniae ） isolates and the risk factors of bloodstream infections caused by these strains. Methods Clinical data of 131 patients with E. coli or K. pneumoniae-induced bloodstream infections admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University during September 2009 and June 2014 were retrospectively analyzed. Species identification and antimicrobial susceptibility test were performed by Vitek 2 system, and ESBLs production was tested by standard disk diffusion method. Logistic regression analysis was performed to identify the risk factors of bloodstream infections induced by ESBLs-producing strains. Results Among 131 patients, 65 were infected with ESBLs-producing strains, and 66 were infected with non-ESBLs-producing strains. The resistance rates of ESBLs-producing strains were above 50% for penicillin, aztreonam and third/fourth generation cephalosporins, which were significantly higher than those of non-ESBLs producing strains. The resistance rates of ESBLs-producing E. coli and K. pneumoniae to carbapenems and piperacillin/ tazobactam were 0-2. 0% , 2. 3% and 0-14.3% , 26.7% , respectively. The univariate analysis revealed that patients with exposure to cephalosporins in recent 3 months （χ^2 = 18. 322, P 〈 0. 01 ） , prior infection with ESBLs-producing strains （χ^2 = 14. 610, P 〈0. 01 ） , indwelling catheter in recent 3 months （χ^2 = 13. 016, P 〈0. 01 ）, history of hospitalization in recent 3 months （χ^2 = 11. 269, P 〈0. 01 ）, exposure to quinolones in recent 3 months （χ^2 = 10. 638, P 〈 0. 01 ）, nosocomial infection （χ^2 = 8. 205, P 〈 0. 01 ）, history of indwelling deep venous catheter or percutaneous central catheter in recent 3 months （χ^2 =4. 817, P 〈0.05 ） and exposure to glucocorticoid hormone in recent 3 months （χ^2 = 4. 265, P 〈 0. 05 ） were a

关 键 词：Β-内酰胺酶类 大肠杆菌 克雷伯菌 肺炎 血流感染 微生物敏感性试验 危险因素 

分 类 号：R446.5[医药卫生—诊断学]