急诊科大肠埃希菌耐药性及多重耐药大肠埃希菌感染危险因素的研究

陈宁; 钟如柱; 苏耿; 杨锐能; 周鹰豪

doi:10.13201/j.issn.1009-5918.2015.12.018

急诊科大肠埃希菌耐药性及多重耐药大肠埃希菌感染危险因素的研究

- 1. 廉江市人民医院急诊科(广东廉江, 524400);
- 2. 湛江中心人民医院急诊科;
- 3. 湛江市第二人民医院检验科
基金项目:
湛江市科技攻关项目（No：2014B01184）

详细信息

通讯作者: 陈宁,E-mail:2023204956@qq.com

中图分类号: R446.5

收稿日期: 2015-08-02

Study on the drug resistance of escherichia coli and risk factors of multidrug resistant escherichia coli infection which come from emergency department

- 1. Department of Emergency, the People's Hospital of Lianjiang, Lianjiang 524400, China;
- 2. Department of Emergency, Central People's Hospital of Zhanjiang;
- 3. Department of Clinical Laboratory, the Second People's Hospital of Zhanjiang

More Information

Corresponding author: CHEN Ning, E-mail: 2023204956@qq.com

Received Date: 02 August 2015

摘要

摘要: 目的：探讨急诊科大肠埃希菌（EC）的耐药性及感染多重耐药大肠埃希菌（MREC）的危险因素。方法：收集2014-01-2015-06 EC 208株，分别采用全自动微生物分析仪和琼脂稀释法鉴定细菌和检测药物敏感性。根据药物敏感性结果，分别把二级医院EC分为耐药菌组（A组）和多重耐药菌组（B组），而三级医院则分为耐药菌组（C组）和多重耐药菌组（D组），统计EC的药物敏感性结果、感染部位和MREC感染危险因素，采用χ²检验和多因素Logistic回归分析数据。结果：MREC在二、三级医院中分别占EC的70.11%（61/87）和62.81%（76/121）。头孢他啶、环丙沙星、呋喃妥因在B组耐药率明显高于A组，而头孢他啶、阿米卡星、复方新诺明在D组耐药率明显高于C组（P<0.05）。B组泌尿道系统感染明显多于A组，而D组血液系统感染明显多于C组（P<0.05）。进EICU ≥ 7 d、侵入性操作和住院 ≥ 15 d是二级医院急诊科患者感染MREC的独立危险因素。而三级医院的独立危险因素则是进EICU ≥ 7 d、侵入性操作和卧床 ≥ 10 d。结论：急诊科EC的耐药形势严峻，其耐药性、感染部位和MREC感染危险因素在二、三级医院中有相同之处亦有不同之处。
- 大肠埃希菌 /
- 耐药性 /
- 急诊科 /
- 危险因素
Abstract: Objective: Investigate the drug resistance of escherichia coli (EC) and risk factors of multidrug resistant escherichia coli (MREC) infection which come from emergency department.Method: No repeat 208 strains of EC were collected From January 2014 to June 2015.The EC which come from the grade 2 hospital were defined as group A (drug resistance bacteria group) and group B (multidrug resistant bacteria group),and the EC which come from the grade 3 hospital were defined as group C (drug resistance bacteria group) and group D (multidrug resistant bacteria group)according to the result of drug susceptibility.The automated microbiology analyzer and agar dilution method were used to bacteria identification and detections of drug sensitivity.The results of drug susceptibility,infection system and risk factors of MREC infection were measured,and the chi-square test and multifactor logistic regression analysis were used by data analysis.Result: The MREC were 70.11%(61/87) and 62.81%(76/121) in the grade 2 hospital and grade 3 hospital.The drug-resistance rates of group B to ceftazidime,Ciprofloxacin,nitrofurantoin were all significantly higher than those of group A,while drug-resistance rates of group D to ceftazidime,amikacin,bactrim were all significantly higher than those of group C (all P<0.05).Urinary tract infection in the group B was significantly more than those of group A,and the hematological system infection in the group D was significantly more than those of group C (all P<0.05).The independent risk factors of MREC infection were "stay EICU ≥ 7 days","invasive procedures" and "hospitalization ≥ 15 days" in grade 2 hospital,while were "stay EICU ≥ 7 days","invasive procedures" and "lying in bed ≥ 10 days" in grade 3 hospital.Conclusion: The drug-resistance situation of EC is serious in the emergency department in western Guangdong province,and there are both similarities and differences in resistance characteristics,infection system and risk factors of MREC infection between the emergency department of grade 2 hospital and the emergency department of grade 3 hospital.
- escherichia coli /
- resistance /
- emergency department /
- risk factors

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参考文献(17)

[1]	龙志伟,廖彧,林绍怡,等.2012-2014医院急诊科感染患者病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(3):522-524.
[2]	周春莲,陈惠清,某三级医院医院感染风险评估[J].中华医院感染学杂志,2015,25(2):360-362.
[3]	Garnacho-Montero J,Amaya-Villar R.Multiresistant Acinetobacter baumannii infections:epidemiology and management[J].Curr Opin Infect Dis,2010,23:332-339.
[4]	Clinical and Laboratory Standard Institute.Performance Standards for Antimicrobial Disk Susceptibility Tests;fifteon information supplement.Supplement.Clinical and Laboratory Standards Institute(formerly NCCLS)[M].9thed.Wayne:PA,2014:44-49.
[5]	蔡木发,李静,罗虹烈,等.大肠埃希菌超广谱β-内酰胺酶的检测及多重耐药性分析[J].中国卫生检验杂志,2014,24(10):1496-1499.
[6]	Palmer L B,Smaldone G C.Reduction of bacterial resistance with inhaled antibiotics in the intensive care unit[J].Am J Respir Crit Care Med,2014,189:1225-1233.
[7]	胡付品,朱德妹,汪复,等.2013年上海市细菌耐药性监测[J].中国感染与化疗杂志,2014,14(6):461-473.
[8]	Licker M,Anghel A,Moldovan R,et al.Genotype-phenotype correlation in multiresistant Escherichia coli and Klebsiella pneumoniae strains isolated in Western Romania[J].Eur Rev Med Pharmacol Sci,2015,19:1888-1894.
[9]	钟如柱,许志明,喻云梅,等.COPD患者呼吸道感染铜绿假单胞菌的耐药性及ESBLs检测[J].中国临床研究,2015,28(2):155-158.
[10]	杨青,陈晓,孔海深,等.Mohnarin 2011年度报告:尿标本细菌耐药监测[J].中华医院感染学杂志,2012,22(24):5503-5507.
[11]	许亚茹,尚秀娟,李冬霞.新生儿重症监护室医院感染管理现状[J].中国感染控制杂志,2010,9(4):287-288.
[12]	Aiassa V,Barnes A I,Albesa I.Resistance to ciprofloxacin by enhancement of antioxidant defenses in biofilm and planktonic Proteus mirabilis[J].Biochem Biophys Res Commun,2010,393:84-88.
[13]	纪风兵,卓超.老年卒中相关性肺炎发生多重耐药菌感染的危险因素及病原学分析[J].中国抗生素杂志,2012,37(10):795-800.
[14]	周翠香,于雪梅,何小平.急诊科重症患者医院感染的危险因素调查[J].中华医院感染学杂志,2014,24(5):1141-1143.
[15]	莫焕桐,陈小丽,陈伟忠.院内下呼吸道多重耐药菌感染的特点及危险因素[J].广东医学,2014,35(16):2581-2583.
[16]	余晗俏,俞章平,钟忆周.心内科住院患者医院感染病原菌与耐药性分析[J].中华医院感染学杂志,2015,25(9):1962-1964.
[17]	Lim C J,Cheng A C,Kennon J,et al.Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities:a nested case-control study[J].J Antimicrob Chemother,2014,69:1972-1980.