产AmpC酶阴沟肠杆菌感染特征与相关因素分析  

Characteristics and related factors for AmpC-producing Enterobacter cloacae infection

作　　者：谢朝云 陈应强 熊芸 孙静 杨忠玲 杨怀[4] XIE Zhao-yun;CHEN Ying-qiang;XIONG Yun;SUN Jing;YANG Zhong-ling;YANG Huai(The Third Affiliated Hospital of Guizhou Medical University, Tuyun, Guizhou 558000, China)

机构地区：[1]贵州医科大学第三附属医院感染管理科,贵州都匀558000 [2]贵州医科大学第三附属医院感染科,贵州都匀558000 [3]贵州医科大学第三附属医院检验科,贵州都匀558000 [4]贵州省人民医院感染管理科,贵州贵阳550002

出　　处：《中华医院感染学杂志》2018年第9期1429-1431,1435,共4页Chinese Journal of Nosocomiology

基　　金：贵州省科技厅基金资助项目(黔科合LH字[2014]7162号);贵州省黔南州社会发展科技基金资助项目(黔南科合社字[2013]20号)

摘　　要：目的分析产AmpC酶阴沟肠杆菌感染患者的临床特征与感染相关因素,为制定预防策略提供依据。方法选取2016年1月-2017年7月单株阴沟肠杆菌感染患者587例为研究对象,Phoenix-100全自动细菌鉴定药敏系统进行细菌鉴定及药敏试验,采用酶提取物三维试验法检测其产AmpC酶,单因素及非条件Logistic回归分析患者产AmpC酶阴沟肠杆菌感染的相关影响因素。结果 587例患者共分离587株阴沟肠杆菌,其中产AmpC酶阴沟肠杆菌217株,占36.97%;产AmpC酶阴沟肠杆菌主要分离自痰液、尿液和引流液,病房分布主要以ICU、普外科和神经外科为主,分别占29.03%、19.35%和14.29%;入住ICU、腹腔引流、糖皮质激素、使用头孢类抗菌药物和使用头孢加酶抑制剂抗菌药物是产AmpC酶阴沟肠杆菌感染的独立影响因素。结论产AmpC酶阴沟肠杆菌检出率较高,医院应针对影响因素加强医院感染管理,尤其是减少不必要入住ICU、规范引流管操作和慎用头孢类抗菌药物与糖皮质激素,减少产AmpC酶阴沟肠杆菌感染发生。OBJECTIVE To investigate the clinical characteristics of patients with AmpC-producing Enterobacter cloacae infection and analyze the related factors so as to put forward the prevention strategies.METHODS A total of587 patients with single E.cloacae infection who were treated from Jan 2016 to Jul 2017 were recruited as the study objects,bacterial identification and drug susceptibility testing were carried out by using Phoenix-100 automatic bacterial identification and drug susceptibility system,the AmpC enzyme was detected by means of three-dimensional test of enzyme extracts,and univariate analysis and non-conditional logistic regression analysis were performed for the influencing factors for the AmpC-producing E.cloacae infection.RESULTS Totally 587 strains of E.cloacae were isolated from 587 patients,217（36.97%）were AmpC-producing E.cloacae.The AmpC-producing E.cloacae strains were mainly isolated from sputum,urine and drainage fluid specimens.29.03% of the strains were isolated from ICU,19.35%from general surgery department,14.29%from neurosurgery department.The independent influencing factors for the AmpC-producing E.cloacae infection included the ICU stay,abdominal drainage,corticosteroids,use of cephalosporins and use of cephalosporins plus enzyme inhibitors.CONCLUSIONThe isolation rate of the AmpC-producing E.cloacae is high,it is necessary for the hospital to stringent the control of nosocomial infection aiming at the influencing factors,shorten the length of ICU stay,standardize the procedures of drainage and reasonably use cephalosporins and corticosteroids so as to reduce the incidence of AmpC-producing E.cloacae infection.

关 键 词：产AMPC酶 阴沟肠杆菌 医院感染 危险因素 

分 类 号：R378[医药卫生—病原生物学]