296例成人大肠埃希菌血流感染的危险因素及预后分析  

Risk factors and prognosis analysis for 296 cases of Escherichia coli bloodstream infection in adults

作　　者：陈飞燕 宋贵波[1] 牛敏[1] 单斌[1] 卯建[1] CHEN Feiyan;SONG Guibo;NIU Min;SHAN Bin;MAO Jian(Yunnan Key Laboratory of Laboratory Medicine,Yunnan Clinical Test and Diagnosis Innovation Team,Yunnan Institute of Experimental Diagnosis,Department of Clinical Laboratory,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]云南省检验医学重点实验室,云南省临床检验诊断创新团队,云南省实验诊断研究所,昆明医科大学第一附属医院检验科,昆明650032 [2]云南省红河州金平县人民医院检验科

出　　处：《中国感染与化疗杂志》2021年第2期141-147,共7页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81460322);科技部科技基础资源调查专项(2019FY101209)。

摘　　要：目的探讨成人产超广谱β内酰胺酶(ESBL)大肠埃希菌血流感染的危险因素及对患者预后的影响。方法采用病例对照的研究方法,回顾性收集2017年1月—2019年8月大肠埃希菌血流感染患者296例,其中产ESBL大肠埃希菌血流感染患者191例为观察组,以同期非产ESBL大肠埃希菌血流感染患者105例为对照组,进行血流感染的危险因素分析。按预后分为预后不良组53例和好转组243例,进行预后的危险因素分析。结果296例患者检出的296株大肠埃希菌中产ESBL检出率为64.5%。所有菌株对氨苄西林、头孢唑林、头孢呋辛、哌拉西林、四环素、氨苄西林-舒巴坦、头孢噻肟、头孢曲松和头孢哌酮的耐药率均大于60%;除碳青霉烯类、阿米卡星、甲氧苄啶-磺胺甲■唑和四环素外,产ESBL菌的耐药率均高于非产ESBL菌,差异均有统计学意义(P<0.05)。产ESBL菌感染组患者预后不良率高于非产ESBL菌感染组(21.5%比11.4%),差异有统计学意义(P<0.05)。多因素分析结果显示留置导尿管是产ESBL大肠埃希菌血流感染的独立危险因素。感染性休克、入住ICU、低血红蛋白血症、低白蛋白血症是影响大肠埃希菌血流感染预后的独立危险因素。结论留置导尿管是产ESBL大肠埃希菌血液感染的独立危险因素。感染性休克、入住ICU、低血红蛋白血症和低白蛋白血症是影响大肠埃希菌血流感染预后的独立危险因素,应引起重视以改善预后。Objective To evaluate the risk factors for Escherichia coli bloodstream infections and the associated patient prognosis.Methods A total of 191 patients with extended-spectrumβ-lactamase(ESBLs)-producing E.coli bloodstream infections from January 2017 to August 2019 were reviewed retrospectively in a case-control study.Another 105 patients with bloodstream infection due to non-ESBLs-producing E.coli during the same period were taken as control group to analyze the risk factors for bloodstream infection.The patients were compared in terms of outcome(poor outcome,53 patients;favorable outcome,243 patients)to identify the prognostic factors.Results Among the 296 E.coli strains isolated from the 296 patients,191(64.5%)produced ESBLs.More than 60%of the E.coli isolates were resistant to ampicillin,cefazolin,cefuroxime,piperacillin,tetracycline,ampicillin-sulbactam,cefotaxime,ceftriaxone,and cefoperazone.The ESBLs-producing E.coli strains showed significantly higher resistant rates than non-ESBLs-producing strains to common antibacterial agents except carbapenems,amikacin,tetracycline,and trimethoprim-sulfamethoxazole(P<0.05).Poor outcome was reported in significantly higher percentage of patients with ESBLs-producing strain than in the patients with non-ESBLs-producing strain(21.5%versus 11.4%,P<0.05).Multivariate analysis showed that indwelling urinary catheter was an independent risk factor for bloodstream infection with ESBLs-producing E.coli.Septic shock,ICU admission,low hemoglobin,and low albumin were independent risk factors for poor prognosis.Conclusions Indwelling urinary catheter was an independent risk factor for bloodstream infection with ESBLs-producing E.coli.Septic shock,ICU admission,low hemoglobin,and low albumin should be addressed seriously when treating bloodstream infections for the purpose to improve patient outcome.

关 键 词：超广谱Β内酰胺酶 大肠埃希菌 血流感染 耐药率 预后 危险因素 

分 类 号：R631[医药卫生—外科学] R378.21[医药卫生—临床医学]