产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌血流感染的危险因素分析  

Analysis on Risk Factors of Bloodstream Infection of Extended Spectrumβ-LactamaseProducing Escherichia Coli and Klebsiella Pneumoniae

作　　者：谢清[1] 周颖[2] 孔妍 王梓凝[2] 田硕涵[2] 刘桦[1] 杨靖娴[3] 崔一民[2] XIE Qing;ZHOU Ying;KONG Yan;WANG Zining;TIAN Shuohan;LIU Hua;YANG Jingxian;CUI Yimin(Dept.of Pharmacy,Aerospace Center Hospital,Beijing 100049,China;Dept.of Pharmacy,the First Hospital of Peking University,Beijing 100034,China;Dept of Clinicel Laboratory,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院药剂科,北京100049 [2]北京大学第一医院药剂科,北京100034 [3]航天中心医院检验科,北京100049

出　　处：《中国医院用药评价与分析》2020年第9期1142-1145,1149,共5页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:探讨产超广谱β-内酰胺酶(extended spectrumβ-lactamase,ESBL)大肠埃希菌和肺炎克雷伯菌血流感染的危险因素,为临床预防和识别产ESBL大肠埃希菌和肺炎克雷伯菌引起的血流感染以及合理用药提供理论基础。方法:回顾性分析某三级医院大肠埃希菌和肺炎克雷伯菌血流感染病例的临床资料,采用Logistic回归法,分析产ESBL大肠埃希菌和肺炎克雷伯菌血流感染的危险因素。结果:共纳入280例大肠埃希菌和肺炎克雷伯菌血流感染病例,分离得到大肠埃希菌196株,肺炎克雷伯菌84株;其中,产ESBL大肠埃希菌、产ESBL肺炎克雷伯菌检出率分别为53.57%(105株)、32.14%(27株)。大肠埃希菌感染(OR=3.540,95%CI=1.866~6.719,P<0.001)、近3个月内住院史(OR=2.492,95%CI=1.407~4.414,P=0.002)、近2周内使用头孢菌素类抗菌药物(OR=4.086,95%CI=1.281~13.029,P=0.017)或头孢菌素类抗菌药物/β-内酰胺酶抑制剂复方制剂(OR=4.884,95%CI=1.285~18.560,P=0.020)为产ESBL大肠埃希菌和肺炎克雷伯菌血流感染的独立危险因素。结论:既往住院史、近期使用头孢菌素类抗菌药物或头孢菌素类抗菌药物/β-内酰胺酶抑制剂复方制剂会增加产ESBL大肠埃希菌和肺炎克雷伯菌血流感染的风险,建议临床医师充分评估产ESBL菌株感染的危险因素,选择适宜的抗菌药物。OBJECTIVE:To probe into the risk factors of bloodstream infection of extended spectrumβ-lactamase(ESBL)-producing Escherichia coli and Klebsiella pneumoniae,so as to provide theoretical basis for prevention and identification of bloodstream infection of ESBL-producing E.coli and K.pneumoniae and rational drug application.METHODS:Clinical data of patients with bloodstream infection of ESBL-producing E.coli and K.pneumoniae in a certain gradeⅢhospital were retrospective analyzed,Logistic regression method was adopted to analyze the risk factors of bloodstream infection of ESBL-producing E.coli and K.pneumoniae.RESULTS:Totally 280 patients with bloodstream infection of ESBL-producing E.coli and K.pneumoniae were involved,196 strains of E.coli and 84 strains of K.pneumoniae were isolated;of which the detection rates of ESBL-producing E.coli and ESBL-producing K.pneumoniae were respectively 53.57%(105 strains)and 32.14%(27 strains).E.coli infection(OR=3.540,95%CI=1.866-6.719,P<0.001),hospitalization history in the recent 3 months(OR=2.492,95%CI=1.407-4.414,P=0.002),application of cephalosporin antibiotics(OR=4.086,95%CI=1.281-13.029,P=0.017)or cephalosporin antibiotics/β-lactamase inhibitor compound preparation(OR=4.884,95%CI=1.285-18.560,P=0.020)in the recent 2 weeks were the independent risk factors of bloodstream infection of ESBL-producing E.coli and K.pneumoniae.CONCLUSIONS:Past hospitalization history,recent application of cephalosporin antibiotics or cephalosporin antibiotics/β-lactamase inhibitor compound preparation can increase the risk of bloodstream infections of ESBL-producing E.coli and K.pneumonia.It is recommended that clinicians should fully evaluate the risk factors of ESBL-producing bacterial infection and choose appropriate antibiotics.

关 键 词：大肠埃希菌 肺炎克雷伯菌 血流感染 ESBL 危险因素 

分 类 号：R978.1[医药卫生—药品]