1086例儿童感染产ESBLs大肠埃希菌的耐药性和危险因素分析  

Drug resistance and risk factors of ESBLs-producing Escherichia coli in 1086 children

作　　者：刘东才[1] 邱小梅[1] 邹剑成[1] 陈燕梨[1] 梁杏珍 谭文业[1] LIU Dong-cai;QIU Xiao-mei;ZOU Jian-cheng(Guangdong Zhongshan Boai Hospital,Zhongshan 528400,China)

机构地区：[1]中山市博爱医院药学部,广东中山528400

出　　处：《中国处方药》2021年第8期174-176,共3页Journal of China Prescription Drug

基　　金：2014年广东省中山市科技局项目(2014A1FC143)。

摘　　要：目的1086例儿童感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的耐药性分析和危险因素分析,为预防该菌的感染及临床用药选择提供客观可靠的参考依据。方法选择2016年1月1日~2020年12月31日儿科临床标本中分离的3787例(3787株)大肠埃希菌予以鉴定和药敏试验分析,对产ESBLs大肠埃希菌的耐药性及引起感染的危险因素进行分析。结果3787株大肠埃希菌中存在产ESBLs大肠埃希菌1086株(28.68%)和非产ESBLs大肠埃希菌2701株(71.32%)。产ESBLs大肠埃希菌分布情况在尿液中占比最高435株(40.06%),其次是痰液257株(23.66%)。产ESBLs与非产ESBLs大肠埃希菌在头孢西丁、哌拉西林/他唑巴坦以及亚胺培南耐药性方面对比差异无统计学意义(P>0.05),其余16种常用抗生素,产ESBLs大肠埃希菌耐药性情况较非产ESBLs大肠埃希菌明显更高,差异有统计学意义(P<0.05)。经单因素和多因素Logistic分析发现,患儿年龄<3岁,有侵入性操作以及前期应用第3代头孢菌素类抗生素≥3 d是感染产ESBLs大肠埃希菌的主要危险因素。结论加强院内环境消毒和隔离,尽可能减少侵入性操作和应用第3代头孢菌素类抗生素能够大大降低儿童感染产ESBLs大肠埃希菌风险,建议根据病原学检查、药敏结果及病情状况合理选择安全有效的抗生素。Objective To investigate the drug resistance and risk factors of ESBLs-producing Escherichia coli in 1086 children,and provide reliable reference for prevention of ESBLs-producing Escherichia coli and clinical drug selection.Methods 3787 cases(3787 strains)of Escherichia coli isolated from pediatric clinical samples from January 1,2016 to December 31,2020 in our hospital were selected for identification and drug sensitivity test analysis,and the drug resistance of ESBLs-producing Escherichia coli and the risk factors causing infection were analyzed and controlled.Results There were 1086(28.68%)ESBLs-producing Escherichia coli strains and 2701(71.32%)non-ESBLs-producing Escherichia coli strains among 3787 Escherichia coli strains.The distribution of ESBLs-producing Escherichia coli was highest in urine 435(40.06%),followed by sputum 257(23.66%).There was no statistically significant difference in the resistance of ESBLs-producing and non-ESBLs-producing Escherichia coli to cefoxitin,piperacillin/tazobactam and imipenem(P>0.05),and the resistance of other 16 commonly used antibiotics to ESBLs-producing Escherichia coli was significantly higher than that of non-ESBLsproducing Escherichia coli,with statistical significance(P<0.05).Univariate and multivariate Logistic analysis showed that the main risk factors for ESBLsproducing Escherichia coli infection were the age of the child<3 years old,the invasive operation and the use of the third generation of cephalosporin antibiotics≥3 days in the early stage.Conclusion Strengthening disinfection and isolation in hospital environment,minimizing invasive operation and application of third-generation cephalosporin antibiotics can greatly reduce the risk of ESBLs-producing Escherichia coli infection in children.It is suggested to select safe and effective antibiotics reasonably according to etiological examination,drug sensitivity results and condition status.

关 键 词：儿童 感染 大肠埃希菌 超广谱Β-内酰胺酶 耐药性 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R725.1[医药卫生—临床医学]