大肠埃希菌产超广谱β－内酰胺酶的危险因素研究.docVIP

大肠埃希菌产超广谱β－内酰胺酶的危险因素研究 【摘要】目的探索大肠埃希菌(E.coli)产超广谱β－内酰胺酶(ESBLs)的危险因素，为制定预防控制策略提供科学依据。方法采用抑制剂增强双纸片扩散法检测ESBLs，以桂林某医院微生物实验室首次分离产ESBLs E.coli的病例为病例组，非产ESBLs E.coli的病例为对照组，采用logistic回归分析进行研究。结果213例病例分离出E.coli ESBLs 111例，ESBLs总体阳性率为52.11％，外科阳性率为61.36％，高于内科45.60％。医院感染、住院时间≥7 d、联用抗生素、三代头孢菌素、氟喹诺酮类抗菌药物和β－内酰胺酶抑制剂复合抗生素使用是E.coli产ESBLs的危险因素，其中住院时间≥7 d、三代头孢菌素和联用抗生素是独立危险因素。结论住院病人E.coli 的ESBLs阳性率高，产ESBLs危险因素复杂多样，应该采取综合措施来预防和控制产ESBLs菌株的流行。 【关键词】 大肠杆菌； 危险因素； 病例对照研究 Epidemiological study on Escherichia coli producing extendedspectrum beta;lactamases HUANG Ruijuan, YE Linxiang, Feng Qiming. Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China; Department of Nosocomial Infection Management, Nanxishan Hospital, Guilin 541002, China; Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China; School of Public Health, Guangxi Medical University, Nanning 530021, China 【Abstract】 Objective To explore the risk factors for Escherichia coli (E.coli) producing extendedspectrum beta;lactamases (ESBLs). Methods The isolate rates of 111 cases of E.coli producing ESBLs and 102 cases of control not producing ESBLs were analysed with logistic regression. Results The isolate rate of E.coli was 52.11％. The isolate rate of surgery (61.36%) was higher than that of internal medicine. Hospital infection, hospital stay over 7 days, combined use of antibiotics, use of 3 rd generation cephalosporins, use of the quinolones and use of antibiotic/betalactamases inhibitor were risk factors of E.coli producing ESBLs. Hospital stay over 7 days, combined use of antibiotics and use of 3 rd generation cephalosporins were independent risk factors. Conclusions General measures should be taken to prevent the spread of ESBLs. 【Key words】 Escherichia coli; Risk factors;casecontrol studies 大肠埃希菌是最常见的医院感染病原菌，也是最常见的产超广谱beta;内酰胺酶(ESBLs)的菌种。该菌具有较高的多重耐药性，可通过耐药质粒传递给其他细菌，引起医院感染暴发流行。为探讨桂林地区大肠埃希菌产ESBLs的阳性率及影响因素，对桂林一家综合性医院分离出大肠埃希菌的病例进行病例对照研究。 1 资料与方法 1.1