骨科创面感染产超广谱β-内酰胺酶大肠埃希菌的耐药性及产酶因素分析  

Drug resistance of extended-spectrum β-lactamases-producing Escherichia coli isolated from patients with orthopedic wound infections and enzyme-producing factors

作　　者：孙永宁[1] 石莉娜 张丹晨[1] 陈剑明[1] 庄云强[1] SUN Yong-ning;SHI Li-na;ZHANG Dan-chen;CHEN Jian-ming;ZHUANG Yun qiang(Ningbo NO.6 Hospital, Ningbo, Zhengjiang 315040, China)

机构地区：[1]宁波市第六医院检验科,浙江宁波315040

出　　处：《中华医院感染学杂志》2018年第11期1670-1673,1739,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2018KY704);浙江省医药卫生一般研究计划基金资助项目(2014KYA201)

摘　　要：目的分析骨科创面感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的耐药性及产酶因素,为临床合理用药及预防医院感染提供科学依据。方法回顾性分析2016年1月-2017年6月入住医院发生创面感染大肠埃希菌的130例患者为研究对象,根据耐药性检测和产ESBLs菌株的确认结果将患者分为产ESBLs组与非产ESBLs组;比较两组患者对常用抗菌药物的耐药性;收集患者的临床资料,包括年龄、性别、基础疾病、激素免疫抑制剂使用、留置导管等,对产ESBLs可能的影响因素进行单因素分析及Logistic多元回归分析。结果创面分泌物培养出大肠埃希菌130株,其中检出产ESBLs大肠埃希菌42株占32.3%、非产ESBLs大肠埃希菌88株占67.7%;产ESBLs大肠埃希菌对亚胺培南、美罗培南的耐药率为0,对头孢吡肟、头孢曲松、头孢他啶、氨曲南的耐药率高于非产ESBLs菌株(P<0.05);多因素Logistic回归分析结果显示,多发性损伤、住院时间>30d、入住ICU、多次清创、混合感染、侵袭性操作、使用第三代头孢菌素是创面感染大肠埃希菌产ESBLs的影响因素(P<0.05)。结论产ESBLs大肠埃希菌对抗菌药物具有较高的交叉耐药性和多药耐药现象,临床应严格控制抗菌药物使用,及时根据细菌药物敏感实验合理选用抗菌药物。OBJECTIVE To analyze the drug resistance of extended-spectrumβ-lactamases（ESBLs）-producing Escherichia coli isolated from patients with orthopedic wound infections and enzyme-producing factors so as to provide scientific basis for reasonable clinical use of antibiotics and prevention of nosocomial infections.METHODS A total of 130 patients with E.coli wound infections who were hospitalized from Jan 2016 to Jun 2017 were recruited as the study objects and divided into the ESBLs group and the non-ESBLs group according to the results of detection of drug resistance and confirmation of ESBLs-producing strains.The drug resistance to the commonly used antibiotics was compared between the two groups of patients.The clinical data,including age,genders,underlying diseases,use of hormone immunosuppressants and catheter indwelling,were collected from the patients.The univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for production of ESBLs.RESULTS Totally 130 strains of E.coli were isolated from wound secretions,42（32.3%）of which were ESBLs-producing E.coli,and 88（67.7%）were ESBLs-producing E.coli.The drug resistance rates of the ESBLs-producing E.coli strains to imipenem and meropenem were 0,the drug resistance rates of the ESBLsproducing strains were significantly higher than those of the non-ESBLs-producing strains to cefepime,ceftriaxone,ceftazidime and aztreonam（P〈0.05）.The result of the multivariate logistic regression analysis showed that the influencing factors for the ESBLs-producing E.coli wound infection included the multiple injuries,length of hospital stay more than 30 days,ICU stay,multiple debridement,mixed infection,invasive operation and use of third generation cephalosporins（P〈0.05）.CONCLUSION The ESBLs-producing E.coli strains are highly crossresistant and multidrug-resistant to antibiotics.It is necessary for the hospital to restrain the use of antibiotics and reasonably use antibiotics based on the result of drug suscept

关 键 词：骨科 创面感染 超广谱Β-内酰胺酶 大肠埃希菌 影响因素 

分 类 号：R378[医药卫生—病原生物学]