泌尿外科住院患者耐头孢他啶大肠埃希菌的流行病学及危险因素调查  

The epidemiological investigation and risk factors for ceftazidime resistant escherichia coli from the inpatients of urology department

作　　者：何建春 杨雷 王丹 梅小亿 罗晓 He Jianchun;Yang Lei;Wang Dan;Mei Xiaoyi;Luo Xiao(Medical Clinical Laboratory,Peoples′s Hospital of Dazu County,Chongqing 402360,China)

机构地区：[1]重庆市大足区人民医院检验科,重庆402360

出　　处：《国际泌尿系统杂志》2023年第1期101-106,共6页International Journal of Urology and Nephrology

基　　金：重庆市科卫联合医学科研项目 (2020MSXM072)。

摘　　要：目的探讨泌尿外科住院患者中耐头孢他啶大肠埃希菌的流行病学特点及危险影响因素。方法收集2017年1月到2020年12月本院泌尿外科送检分离培养的非重复大肠埃希菌共406株。根据大肠埃希菌是否对头孢他啶耐药分为耐药组(109例)和敏感组(297例)。使用Vitek 2 Compact对菌株进行药敏测定,采用脉冲场凝胶电泳(PFGE)方法完成细菌同源性分型分析,并使用PCR方法完成耐药基因检测,统计病例资料并进行危险影响因素分析。结果泌尿外科住院患者中大肠埃希菌对头孢他啶的耐药率为26.8%(109/406),主要来源于尿液标本(占89.2%);耐药组细菌对氨苄西林、氨苄西林/舒巴坦、头孢曲松、氨曲南和环丙沙星等呈现出高的耐药率,且耐药组对所有抗生素的耐药率均高于敏感组(均P<0.05)。PFGE同源性分析结果显示29株耐头孢他啶大肠埃希菌呈现出不同条带。PCR结果显示耐头孢他啶大肠埃希菌携带blaCTX-M有73株(占67.0%),携带blaTEM有48株(占44.0%),携带blaSHV有11株(占10.1%)。多因素logistic回归分析结果显示前列腺疾病(OR=2.03,P=0.017)、尿路感染(OR=2.43,P=0.001)、导尿管(OR=1.88,P=0.014)和头孢菌素使用史(OR=1.67,P=0.035)是耐头孢他啶大肠埃希菌感染的独立危险因素。结论泌尿外科耐头孢他啶大肠埃希菌的检出率较高,ESBLs基因以CTX-M基因型为主要流行型别。前列腺疾病、尿路感染、导尿管和头孢菌素使用史是耐头孢他啶大肠埃希菌感染的独立危险因素。因此,临床建议结合耐头孢他啶大肠埃希菌的流行病学特征和药敏谱,合理使用抗生素,减少不必要的侵入性操作,从而预防和控制该类细菌的出现。Objective To investigate the epidemiological characteristics and risk factors for ceftazidime resistant escherichia coli from inpatients of urology department.Methods A total of 406 non-repetitive escherichia coli strains isolated and cultured from inpatients in the department of urology of our hospital from January 2017 to December 2020 were collected and divided into resistant group(n=109)and sensitive group(n=297)according to whether resistant to ceftazidime.Drug sensitivity of escherichia coli strainswas tested by Vitek 2 Compact,the homology of ceftazidime resistant escherichia coli strains was detected by pulsed-field gel electrophoresis(PFGE)method,and the resistant-related gene were characterized by PCR.Results The incidence of ceftazidime resistant escherichia colifrom inpatients in the department of urology was 26.8%(109/406),mainly from urine samples(89.2%).The bacteriaof resistant groupshowed thathigh resistance rates to ampicillin,ampicillin/sulbactam,ceftriaxone,amtronam,and ciprofloxacin,etc,which were higher than those in sensitive group(all P<0.05).The result of PFGE homology analysisrevealed that 29 ceftazidime resistant escherichia coli strains showed different bands.PCR results showed that 109 strains producing ESBLs included the genes blaCTX-M(73 cases,67.0%),blaTEM(48 cases,44.0%),and blaSHV(11 case,10.1%)in resistant group.Logistic regression analysis showed that prostate disease(OR=2.03,P=0.017),urinary tract infection(OR=2.43,P=0.001),urinary catheter(OR=1.88,P=0.014)and the history of cephalosporin use(OR=1.67,P=0.035)was the independent risk factor for ceftazidime resistant escherichia coli infections.Conclusions The rate of Ceftazidime resistant Escherichia coli in urology is high,and CTX-M genotype is the main prevalent type in ESBLs gene.Prostate disease,urinary tract infection,catheter and cephalosporin use were the independent risk factors for Ceftazidime resistant Escherichia coli infection.Hence,it is recommended to use antibiotics rationally and reduce unnecessary invasive proce

关 键 词：泌尿系疾病 头孢他啶 大肠埃希菌 

分 类 号：R699[医药卫生—泌尿科学] R446.5[医药卫生—外科学]