社区产ESBLs大肠埃希菌泌尿系感染的危险因素分析  

Risk Factors Analysis of Community-acquired Urinary Tract Infections Caused by Extended-spectrum β-lactamase-producing Escherichia coli

作　　者：陈夏容[1] 张华平[1] 曾秀玉[1] 黄东红[1] 潘少敏[1] 

机构地区：[1]福建医科大学附属第二医院医院感染管理处,泉州362000

出　　处：《中国循证医学杂志》2016年第2期125-129,共5页Chinese Journal of Evidence-based Medicine

基　　金：福建省教育厅科技项目B类(编号:JB12094);福建省泉州市科技局2012年重点项目(编号:2012Z34);福建医科大学附属第二医院青年苗圃基金课题(编号:2012MP44)

摘　　要：目的探索社区泌尿系感染产ESBLs大肠埃希菌的危险因素。方法采用前瞻性和回顾性调查相结合的方法,纳入福建医科大学附属第二医院2012年7月至2014年12月期间确诊为社区产ESBLs大肠埃希菌泌尿系感染的住院患者为研究对象,进行流行病学调查。采用SPSS19.0软件进行统计分析,使用χ^2检验或Fisher确切概率法进行单因素分析,对差异有统计学意义的研究因素进行多因素logistic回归分析。结果共纳入106例患者,根据药敏结果分为产超广谱β-内酰胺酶（ESBLs）组（68例）和对照组（38例）。单因素分析结果显示,与对照组相比,ESBLs组在入院前3个月内使用抗生素（χ^2=11.292,P=0.001）、使用三代头孢菌素（χ^2=11.033,P=0.001）、尿路梗阻性疾病≥3种（χ^2=16.464,P=0.000）、贫血（χ^2=5.956,P=0.015）、尿管留置史（χ^2=6.695,P=0.010）、泌尿系统手术（χ^2=9.730,P=0.002）等的发生率明显更高,其差异有统计学意义。多因素非条件logistic回归分析结果显示,尿路梗阻性疾病≥3种[OR=14.675,95%CI（2.699,79.796）,P=0.002]、贫血[OR=7.976,95%CI（1.785,35.632）,P=0.007]、入院前3个月内使用抗生素[OR=7.057,95%CI（1.597,31.175）,P=0.010]、使用三代头孢菌素[OR=6.344,95%CI（1.145,35.146）,P=0.034]、尿管留置史[OR=3.844,95%CI（1.058,13.967）,P=0.041]是社区产ESBLs大肠埃希菌泌尿系感染的独立危险因素。结论应严格控制使用抗生素的指征,特别是三代头孢菌素的使用,尽量减少尿管留置,纠正贫血,以降低社区产ESBLs大肠埃希菌尿路感染的发生率。Objective To explore the risk factors of community-acquired urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli（ESBLs-producing Escherichia coli）.Methods Prospective and retrospective investigation methods were combined,to investigate the hospitalized patients diagnosed with community-acquired urinary tract infections caused by ESBLs-producing Escherichia coli in the Second Affiliated Hospital of Fujian Medical University during July 2012 to December 2014.Statistical analysis was performed using SPSS 19.0 software.The potential risk factors were analyzed by chi-square test or Fisher exact probability method,then,factors with statistical significance identified by single factor analysis were further analyzed by non-conditional logistic regression.Results A total of 106 patients were included and divided into a ESBLs group（68 cases） and a control group（38 cases） according to the drug sensitivity test results.The results of single factor analysis indicated：there were significant differences between the ESBLs group and the control group in the use of antibiotics within three months before admission（χ~2=11.292,P=0.001）,the use of third generation cephalosporin（χ~2=11.033,P=0.001）,more than three kinds of diseases that could cause urinary tract obstruction（χ~2=16.464,P=0.000）,anemia（χ~2=5.956,P=0.015）,indwelling catheter（χ~2=6.695,P=0.010）,urinary system operations（χ~2=9.730,P=0.002）.The results of further non-conditional logistic regression analysis showed that more than three kinds of diseases that could cause urinary tract obstruction（OR=14.675,95%CI 2.699 to79.796,P=0.002）,anemia（OR=7.976,95%CI 1.785 to 35.632,P=0.007）,the use of antibiotics within three months before admission（OR=7.057,95%CI 1.597 to 31.175,P=0.010）,the use of third generation cephalosporin（OR=6.344,95%CI 1.145 to 35.146,P=0.034） and indwelling catheter（OR=3.844,95%CI 1.058 to 13.967,P=0.041） were independent risk factors of community-acquired

关 键 词：产ESBLs 大肠埃希菌 危险因素 社区 尿路感染 

分 类 号：R446.5[医药卫生—诊断学]