血流感染中产CTX-M型ESBLs大肠埃希菌的分子流行病学和危险因素研究  

Study on the molecular epidemiology and risk factors of producing CTX-M type ESBLs-Escherichia coli in bloodstream infection

作　　者：何建春 董剑 杨雷 裴昌贞 HE Jianchun;DONG Jian;YANG Lei;PEI Changzhen(Department of Clinical Laboratory,Dazu District People′s Hospital,Chongqing 402360,China;Sleep Psychosomatic Center,Dazu District People′s Hospital,Chongqing 402360,China)

机构地区：[1]重庆市大足区人民医院检验科,重庆402360 [2]重庆市大足区人民医院睡眠心身中心,重庆402360

出　　处：《国际检验医学杂志》2020年第12期1460-1464,共5页International Journal of Laboratory Medicine

基　　金：重庆市大足区科学技术委员会基金项目(2015ACC1017)。

摘　　要：目的研究血流感染中产CTX-M型超广谱β-内酰胺酶(ESBLs)-大肠埃希菌(E.coli)的分子流行病学和危险因素。方法收集该院2014年1月至2017年12月血流感染标本中分离的204株E.coli,其中49株产CTX-M型ESBLs-E.coli作为CTX-M组,44株非产CTX-M型ESBLs-E.coli作为非CTX-M组,111株非产ESBLs-E.coli作为对照组。分析产CTX-M型ESBLs-E.coli的耐药率;采用脉冲场凝胶电泳(PFGE)进行产CTX-M型ESBLs-E.coli菌株的同源性分析;分析产CTX-M型ESBLs-E.coli感染的独立危险因素。结果204株E.coli中产ESBLs率为45.6%,产ESBLs-E.coli中共检出blaCTX-M 49株,占52.7%。CTX-M组对庆大霉素、环丙沙星、左氧氟沙星、头孢他啶和头孢吡肟的耐药率高于非CTX-M组(P<0.05)。PFGE结果显示,29株产CTX-M型ESBLs-E.coli菌株属于不同的型别,来源不同,未发现克隆传播。多因素Logistic回归分析结果显示,与非CTX-M组比较,年龄≥60岁、粒细胞减少症、内置引流管和头孢菌素类抗菌药物使用是CTX-M组患者感染产CTX-M型ESBLs-E.coli的独立危险因素(P<0.05);与对照组比较,转院、尿路感染、置入导尿管和头孢菌素类抗菌药物使用是CTX-M组患者感染产CTX-M型ESBLs-E.coli的独立危险因素(P<0.05)。结论产CTX-M型ESBLs-E.coli血流感染的发生率及菌株耐药率均较高,临床应关注产CTX-M型ESBLs-E.coli的流行情况和感染的相关危险因素,并进行早期预防。Objective To study the molecular epidemiology and risk factors of producing CTX-M type extended spectrumβ-lactamase(ESBLs)-Escherichia coli(E.coli)in bloodstream infection.Methods Collected 204 strains of E.coli isolated from bloodstream infection specimens from January 2014 to December 2017 in the hospital.Among them,49 strains producing CTX-M type ESBLs-E.coli as the CTX-M group,44 strains non-producing CTX-M type ESBLs-E.coli as the non-CTX-M group,and 111 strains non-producing ESBLs-E.coli as the control group.The drug resistance rate of producing CTX-M type ESBLs-E.coli was analyzed;pulsed field gel electrophoresis(PFGE)was used to analyze the homology of producing CTM-X type ESBLs-E.coli strains;the independent risk factors of producing CTX-M type ESBLs-E.coli were analyzed.Results The ESBLs production rate of 204 strains of E.coli was 45.5%,and 49 strains of blaCTX-M were detected in producing ESBLs-E.coli,accounting for 52.7%.The drug resistance rate of CTX-M group to gentamicin,ciprofloxacin,levofloxacin,ceftazidime and cefepime was higher than that of non-CTX-M group(P<0.05).PFGE results showed that the 29 strains of producing CTX-M type ESBLs-E.coli belonged to different types and came from different sources,no clonal transmission had been found.The results of multiple Logistic regression analysis showed that compared with non-CTX-M group,age≥60 years old,neutropenia,internal drainage tube and use of cephalosporins were the independent risk factors of producing CTX-M type ESBLs-E.coli infection in CTX-M group(P<0.05);compared with the control group,hospital transfer,urinary tract infection,urinary catheter placement,and use of cephalosporins were the independent risk factors of producing CTX-M type ESBLs-E.coli infection in CTX-M group(P<0.05).Conclusion The incidence of producing CTX-M type ESBLs-E.coli bloodstream infection and the rate of drug resistance are high.We should pay attention to the prevalence of producing CTX-M type ESBLs-E.coli and the related risk factors of infection,and carry out

关 键 词：大肠埃希菌 超广谱Β-内酰胺酶 脉冲场凝胶电泳 血流感染 

分 类 号：R446.5[医药卫生—诊断学]