白血病患者产ESBLs大肠埃希菌感染情况、危险因素及耐药性分析  

The prevalence of ESBL-producing Escherichia coli infections,risk factors,and drug resistance in patients with leukemia at Qinghai University Hospital

作　　者：李娟 黄文辉[1] 何轶群[1] 张磊[1] LI Juan;HUANG Wen-hui;HE Yi-qun;ZHANG Lei(Clinical Laboratory,Qinghai Uniuersity Hospital,Xining,China 810000)

机构地区：[1]青海大学附属医院检验科,青海西宁810001

出　　处：《中国病原生物学杂志》2020年第12期1460-1463,1468,共5页Journal of Pathogen Biology

摘　　要：目的检测白血病患者产超广谱β内酰胺酶ESBLs大肠埃希菌感染情况及耐药性,并分析感染的危险因素。方法2016年1月至2020年1月在青海大学附属医院血液内科住院治疗的合并大肠埃希菌血流感染的白血病患者156例,血培养检查产ESBLs大肠埃希菌感染情况,Kirby-Bauer纸片扩散法进行药敏试验;收集患者相关临床及实验室资料信息,分析白血病患者大肠埃希菌血流感染危险因素。结果血培养检查分离自156例患者的大肠埃希菌菌株中产ESBLs大肠埃希菌85株,占54.49%(85/156);多因素非条件Logistic回归分析显示,AML、发热前粒细胞缺乏>7 d、抗生素暴露史均是白血病患者产ESBLs大肠埃希菌感染的独立危险因素(均P<0.05或P<0.01)。产ESBLs大肠埃希菌中MDR菌株76株,ESBLs阴性大肠埃希菌中MDR菌株43株。产ESBLs大肠埃希菌对氨苄西林、头孢唑啉、头孢噻肟钠、头孢曲松、环丙沙星、左氧氟沙星、氨曲南的耐药率为48.24%~100.00%,ESBLs阴性大肠埃希菌为19.72%~83.1%,差异均有统计学意义(均P<0.05);产ESBLs和ESBLs阴性大肠埃希菌均对阿米卡星、美罗培南、亚胺培南、替加环素、多粘菌素B均敏感。结论白血病患者产ESBLs大肠埃希菌感染率较高且具有不同程度的耐药性,应加强对AML、发热前粒细胞缺乏、抗生素暴露史的高危患者进行监测,一旦感染应及时给予敏感性抗生素治疗。Objective To determine the prevalence of an infection with ESBL-producing Escherichia coli in patients with leukemia,to determine its drug resistance,and to analyze the risk factors for infection.Methods Subjects were 156 patients with leukemia and a bloodstream infection with Escherichia coli who were seen by Hematology at Qinghai University Hospital from January 2016 to January 2020.ESBL-producing E.coli was detected using a blood culture,and a drug sensitivity test was conducted using the Kirby Bauer disk diffusion method.Clinical and laboratory data were collected to analyze the risk factors for an E.coli bloodstream infection in patients with leukemia.Results Blood culture indicated that 85 strains of E.coli produced ESBLs,accounting for 54.49%(85/156).Multivariate unconditional logistic regression analysis indicated that AML,febrile agranulocytopenia>7 d,and a history of antibiotic exposure were independent risk factors for development of an ESBL-producing E.coli infection in patients with leukemia(P<0.05 or P<0.01 for all).Of ESBL-producing E.coli strains,89.41%(76/85)were MDR.Of non-ESBL-producing E.coli strains,60.56%(43/71)were MDR.The resistance of ESBL-producing E.coli to ampicillin,cefazolin,cefotaxime sodium,ceftriaxone,ciprofloxacin,levofloxacin,and aztreonam ranged from 48.24%-100.00%.The resistance of ESBLs negative E.coli to ampicillin,cefazolin,cefotaxime sodium,ceftriaxone,ciprofloxacin,levofloxacin,and aztreonam ranged from 19.72%-83.1%.The differences in resistance were significant(P<0.05 for all).Both ESBL-producing and non-ESBL-producing E.coli strains were sensitive to amikacin,meropenem,imipenem,tigecycline,and polymyxin B.Conclusion Patients with leukemia were infected with ESBL-producing E.coli at a high rate,and E.coli had different degrees of drug resistance.The monitoring of high-risk patients for AML,febrile agranulocytosis,and a history of antibiotic exposure should be enhanced.Once a patient is infected,sensitive antibiotics to which E.coli is sensitive should be promptly adminis

关 键 词：白血病 超广谱Β内酰胺酶 大肠埃希菌 危险因素 耐药性 

分 类 号：R378.21[医药卫生—病原生物学]