产超广谱β-内酰胺酶阴沟肠杆菌感染的医院内分布及危险因素分析  

Risk factors analysis and distrbution for infections caused by extended-spectrum β-lactamase-producing Enterobacter cloacae

作　　者：张秋萍 叶飞娣[3] 张仲明[3] 赖文杰[3] 黄莎莎[3] 张文萍[3] 

机构地区：[1]深圳市罗湖区妇幼保健院妇产科,广东深圳518019 [2]深圳市第三人民医院妇产科,广东深圳518114 [3]深圳市第三人民医院检验科,广东深圳518114

出　　处：《热带医学杂志》2017年第11期1527-1531,共5页Journal of Tropical Medicine

基　　金：深圳市知识创新计划项目(JCYJ20150402111430615;ZDSYS201504301534057)

摘　　要：目的分析产超广谱β-内酰胺酶(ESBLs)阴沟肠杆菌(E.cloa)耐药的危险因素,为干预院内感染采取相应的措施和指导临床合理用药提供科学的依据。方法收集住院患者送检标本检出的非重复阴沟肠杆菌132株,查阅患者病历相关数据做回顾性病例对照分析。采用双纸片协同试验对测出的产ESBLs-E.cloa行确证试验,统计分析产ESBLs-E.cloa的独立危险因素。结果 132株E.cloa中产ESBLs-E.cloa菌株占27.3%;分离的产ESBLs-E.cloa标本主要为肺泡灌洗液、胆汁、咽拭子、血液、胸腹水、尿液和引流物,其中肺泡灌洗液占58.3%、胆汁占8.3%,病区分布主要以结核病区、儿科、外科、肝病区、感染科、综合ICU和内科为主,其中结核区占41.7%、儿科占22.2%和外科占11.1%;男性、侵入性操作、使用过第三代头孢菌素类、碳青霉烯类和耐头孢吡肟是产ESBLs-E.cloa医院感染的主要危险因素(P<0.05);男性、侵入性操作和第三代头孢菌素类药物的使用为独立危险因素。结论医院应加强抗菌药物管理的监测,根据药敏试验结果和其耐药机制检测报告选药,特别对使用过抗生素并有过侵入性操作的男性患者,限制使用头孢菌素类药物,减少产ESBLs-E.cloa的发生和院内传播。Objective To analyze the clinical characteristics of extended-spectrum β -lactamase（ESBLs）-producing Enterobacter cloacae（E.cloa） and observe the risk factors for infections so as to provide scientific basis for prevention of hospital nosocomial infection and offer scientific basis to guide the clinical medication. Methods 132 strains of non-repetitive Enterobacter cloacae were isolated from the submitted specimens that were obtained from the patients who were hospitalized. The confirmatory test was conducted for the isolated ESBLs-producing E.cloa with the use of double disk synergy test,and the risk factors for the ESBLs-producing E.cloa infections were statistically analyzed. Results A total of 36 strains of ESBLs-producing E.cloa were identified among the 132 strains of E. cloa, accounting for 27.3%. The ESBLs-producing E.cloa strains were mainly isolated from the bronchoalveolar lavage fluid（BALF）, bile, pharyngeal swab, blood, chest and ascetic fluid, the urine and drain.58.3% were isolated from the BALF, and 8.3% were isolated from the bile. The ESBLs-producing E.cloa strains were mainly isolated from the tuberculosis department, the pediatrics department, the surgery department, the liver disease area,the comprehensive ICU and the physician department, and 41.7% were isolated from the tuberculosis department, 22.2% were isolated from the pediatrics department,and 11.1% were isolated from the surgery department. The leading risk factors for the ESBLs-producing E.cloa infections included male,invasive operation,used the third generation cephalosporins,use of the Carbapenems drugs and resistance to cefepime（P〈0.05）. Male,invision operation and used the third generation cephalosporins were the independent risk factors. Conclusion Hospital should strengthen the monitoring of antimicrobial drug management. Antibiotics should be chosen according to the results of drug sensitive test and the drug-resistant mechanism. For those patients had taken anitibiotics and for males who had invasive opera

关 键 词：产超广谱Β-内酰胺酶 阴沟肠杆菌 医院感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]