肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶菌株的临床特点及感染的危险因素  

Distribution and antibiotic resistance of ESBLs-producing Klebsiella pneumoniae and Eschedchia coli clinical isolates and risk factors of infection

作　　者：余悦能 张祎萍 金旭红 钱文坚 

机构地区：[1]义乌市中医医院检验科,322000

出　　处：《浙江医学》2016年第10期728-731,734,共5页Zhejiang Medical Journal

基　　金：义乌市科研计划项目(13-3-10)

摘　　要：目的 探讨2012-2014年肺炎克雷伯菌（KPN）和大肠埃希菌（ECO）产超广谱β-内酰胺酶（ESBLs）菌株的临床分布、耐药性及危险因素,为临床合理使用抗生素及医院感染防控提供依据.方法 采用双纸片协同试验确认产ESBLs菌株,法国生物梅里埃ATB细菌鉴定仪对临床分离的病原菌进行菌种鉴定及药敏试验.采用多因素logistic回归分析评估产ESBLs耐药菌感染的独立危险因素.结果 2012、2013、2014年肺炎克雷伯菌检出率分别为13.7％、19.3％、21.4％;大肠埃希菌检出率为34.5％、41.2％、49.6％,呈逐年上升的趋势,且大肠埃希菌产ESBLs的检出率明显高于肺炎克雷伯菌（均P＜0.05）;产ESBLs肺炎克雷伯菌主要从痰液中检出,产ESBLs大肠埃希菌主要从尿液中检出;产ESBLs菌株对常用抗菌药物的耐药率普遍高于非产ESBLs菌株（均P＜0.05）.产ESBLs菌株对青霉素类耐药率为92.5％～ 100.0％、对除头孢西丁外的头孢菌素类、喹诺酮类、磺胺类的耐药性超过50％,产ESBLs肺炎克雷伯菌和大肠埃希菌菌株对阿米卡星的耐药率分别为6.3％、5.2％,对哌拉西林/他唑巴坦的耐药率分别为15.6％、13.3％,对亚胺培南和美罗培南的耐药率最低;影响产ESBLs菌株感染的因素为：年龄≥55岁（OR=3.02,P=0.012）、住院≥15d（OR=3.76,P=0.008）、侵入性置管（OR=6.30,P=0.001）、使用糖皮质激素（OR=4.23,P=0.003）、使用喹诺酮类药物（OR=4.62,P=0.002）、使用第三代头孢菌素（OR=4.51,P=0.004）.结论 产ESBLs肺炎克雷伯菌和大肠埃希菌耐药现象严重,呈多重耐药,临床上应加强监测产ESBLs菌株的耐药情况,减少产ESBLs菌株的危险因素,科学合理应用抗菌药物,延缓细菌耐药性的变迁.Objective To investigate the clinical distribution,drug resistance and risk factors of Klebsiella pneumoniae （KPN） and Escherichia coli （ECO） from 2012 to 2014 in Yuwu TCM Hospital.Methods The extended-spectrum β-Iactamases （ESBLs）-producing bacteria were detected by using the double-disk synergy testing.Pathogens identification and drug susceptibility test were performed for clinical isolated strains using BioMerieux ATB bacteria detection machine.Multivariate Logistic regression analysis was performed to analyze the risk factors of infection of ESBLs-producing E.coli and K.pneumonia.Results The detection rates of ESBLs-producing K.pneumonia were 13.7％,19.3％ and 21.4％ in 2012,2013 and 2014,respectively;while the detection rates of ESBLs-producing E.coli were 34.5％,41.2％ and 49.6％,respectively.The increase of detection rate by year of ESBLs-producing E.coli was higher than that of ESBLs-producing K.pneumonia（P＜0.05）.K.pneumoniae was more commonly isolated from sputum （67.2％）,E.coli was more commonly from urine （65.2％）.The drug resistance rates of ESBLs-producing bacterial isolates were higher than that of non-ESBLs-producing bacterial isolates （P＜0.05）.Drug resistance rate of ESBLs-producing bacteria to penicillins was the highest （92.5％～100.0％）,the rates of resistance to aminoglycosides （amikacin excluded）,quinolones and sulphonamides were over 50％,that to amikacin was 6.3％ and 5.2％,to Piperacillin/Tazobactam was 15.6％ and 13.3％,the lowest resistance was found in imipenem and meropenem.Multivariate Logistic regression analysis showed that the independent risk factors of ESBLs-producing bacterial infections were：aged ＞55 years （OR=3.02,P=0.012）,length of hospital stay ＞15d （OR=3.76,P=0.008）;invasive catheterization （OR=6.30,P=0.001）,administration of glucocorticoid hormone （OR=4.23,P=0.003）,quinolones （OR=4.62,P=0.002）,and the third generation cephalosporins （OR=4.51,P=0.004）.Conclusion The status of drug resist

关 键 词：肺炎克雷伯菌 大肠埃希菌 超广谱Β-内酰胺酶 耐药性 危险因素 

分 类 号：R446.5[医药卫生—诊断学]