[1]何建春,董　剑,杨　雷,等.亚胺培南异质性耐药大肠埃希菌血流感染流行病学及危险因素调查[J].新乡医学院学报,2021,38(2):141-145.[doi:10.7683/xxyxyxb.2021.02.009]
　HE Jianchun,DONG Jian,YANG Lei,et al.Investigation on epidemiology and risk factors for infection of imipenem-heteroresistant Escherichia coli in bloodstream[J].Journal of Xinxiang Medical University,2021,38(2):141-145.[doi:10.7683/xxyxyxb.2021.02.009]
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亚胺培南异质性耐药大肠埃希菌血流感染流行病学及危险因素调查
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年2
页码:
141-145
栏目:
临床研究
出版日期:
2021-02-05

文章信息/Info

Title:
Investigation on epidemiology and risk factors for infection of imipenem-heteroresistant Escherichia coli in bloodstream
作者:
何建春1; 董　剑1; 杨　雷1; 赵俊英1; 裴昌贞2
（1.重庆市大足区人民医院检验科，重庆　402360；2.重庆市大足区人民医院睡眠心身中心，重庆　402360）
Author(s):
HE Jianchun1; DONG Jian1; YANG Lei1; ZHAO Junying1; PEI Changzhen2
(1.Medical Clinical Laboratory,People′s Hospital of Dazu County in Chongqing,Chongqing 402360,China2.Sleep Psychosomatic Center,People′s Hospital of Dazu County in Chongqing,Chongqing 402360,China)
关键词:
大肠埃希菌; 血流感染; 超广谱β-内酰胺酶; 亚胺培南异质性耐药; 菌落谱型分析
Keywords:
Escherichia colibloodstream infectionextended spectrum β-lactamasesimipenem heteroresistancepopulation analysis profile
分类号:
R446.5
DOI:
10.7683/xxyxyxb.2021.02.009
文献标志码:
A
摘要:
目的　调查亚胺培南异质性耐药(IPM-HR)大肠埃希菌(E.coli)血流感染流行病学特点 及危险因素。方法　收集2016年1月至2018年12月重庆市大足区人民医院住院患者血液标本分离的非重复E.coli共163株。使用Vitek2进行菌株药物敏感性测定，并进行超广谱β-内酰胺酶(ESBLs)检测。采用纸片扩散法和菌落谱型分析进行IPM-HR 筛选和表型分析，聚合酶链反应检测耐药基因，脉冲场凝胶电泳分析菌株分子流行病学。将血液标本分离出IPM-HR-E.coli 的患者设为病例组(n=65例)，分离出IPM敏感E.coli的患者设为对照组(n=93例)；收集2组患者年龄、肺部感染、腹腔感染、感染前手术史、机械通气、气管插管和抗生素使用情况等临床资料，采用χ2检验进行单因素分析，对单因素分析中P≤0.10的变量使用logistic回归模型进行独立危险分析。结果　163株E.coli中，IPM-HR菌株65株(占39.8%)，其中31株为产ESBLs IPM-HR-E.coli；IPM敏感菌株93株（占57.1%），IPM耐药菌株5株(占3.1%)。IPM-HR-E.coli标本主要来源于泌尿外科［15例(23.1%)］、重症监护室(ICU)［11例(16.9%)］、肾内科［9例(13.8%)］、普外科［8例(12.3%)］和消化 内科［5例(7.7%)］。对照组E.coli对氨苄西林、头孢他啶、头孢曲松和头孢吡肟的耐药率分别为87.1%、33.3%、41.9%和14.0%，病例组E.coli对氨苄西林、头孢他啶、头孢曲松和头孢吡肟的耐药率分别为96.9%、61.5%、69.2%和27.7%；病例组对氨苄西林、头孢他啶、头孢曲松和头孢吡肟的耐药率显著高于对照组(P<0.05)。21 株IPM-HR-E.coli同源性分析显示不同条带。31株产ESBLs IPM-HR-E.coli中，共检出blaCTX-M 21株，占67.7%；9株(29.0% )表达blaTEM，1株(3.2% )表达blaSHV。单因素分析结果显示，入住ICU、尿路感染、感染前手术史、静脉置管、肠外营养、导尿管、产ESBLs、头孢菌素类抗生素和碳青霉烯类抗生素使用是IPM-HR-E.coli血流感染的主要危险因素(P<0.05)。Logistic回归分析显示，尿路感染［比值比（OR）=2.361，P=0.049］、感染前手术史(OR=2.966，P=0.036)、碳青霉烯类抗生素使用(OR=3.396，P=0.018)和产ESBLs(OR=4.066，P=0.001)是IPM-HR-E.coli血流感染的独立危险因素。结论　IPM-HR-E.coli血流感染的发生率较高，尿路感染、感染前手术史、碳青霉烯类抗生素使用和产ESBLs与IPM-HR-E.coli血流感染有关，临床中应减少侵入性操作，合理使用抗生素以减少IPM-HR-E.coli血流感染的发生。
Abstract:
Objective　To investigate the epidemiology and risk factors for infection of imipenem(IPM)-heteroresistant(HR) Escherichia coli (E.coli) strains in bloodstream.Methods　　A total of 163 non-duplicate E.coli strains isolated from blood specimens of inpatients admitted to People′s Hospital of Dazu County in Chongqing from January 2016 to December 2018 were collected.The drug susceptibility was determined by Vitek2,and extended spectrum beta-lactamases (ESBLs) was detected;heteroresistance phenotype was preliminarily screened by disk diffusion method and then verified by population analysis profile.Resistance gene was detected by polymerase chain reaction.The molecular epidemiology for IPM-HR E.coli strains was determined by pulsed field gel electrophoresis.Patients with IPM-HR-E.coli strains from blood samples were assigned to the case group (n=65) and the patients with IPM-sensitive E.coli were assigned to the control group (n=93).Clinical data of all patients in the two groups were collected,including age,Pulmonary infection,abdominal infection,operation history,mechanical ventilation,endotracheal intubation and antibiotic use,and they were analyzed by univariate analysis χ2 test,and logistic regression model was used to conduct the independent risk analysis for variables with P≤0.10 in univariate analysis.Results　In the 163 E.coli,65 strains (39.8%) were IPM-HR,and of which 31 strains were ESBLs-producing IPM-HR E.coli;93 strains (57.1%) were IPM-sensitive strains, and 5 strains(3.1%) were IPM-resistant strains.The samples with IPM-HR-E.coli were mainly from urology (15 cases,23.1%),intensive care unit (ICU) (11 cases,16.9%),nephrology (9 cases,13.8%),general surgery (8 cases,12.3%) and gastroenterology (5 cases,7.7%).The resistance rates of E.coli to ampicillin,ceftazidime,ceftriaxone and cefepime in the control group were 87.1%,33.3%,41.9% and 14.0%,respectively;the resistance rates of E.coli to ampicillin,ceftazidime,ceftriaxone and cefepime in the case group were 96.9%,61.5%,69.2% and 27.7%,respectively.The resistance rates of E.coli to ampicillin,ceftazidime,ceftriaxone and cefepime in the case group were significantly higher than those in control group (P<0.05).Homology analysis revealed that 21 IPM-HR-E.coli strains had different bands.In the 31 ESBLs-producing IPM-HR-E.coli,the CTX-M genes was in 21 strains (67.7% ),SHV gene in 9 strains(29.0%),and TEM gene in 1 strain(3.2%).Univariate analysis showed that admission to ICU,urinary tract infection,operation history,intravenous catheterization,Parenteral nutrition,catheterization,Production of ESBLs,usage of cephalosporin and carbapenems were the main risk factors for IPM-HR-E.coli (P<0.05).Logistic regression model showed that urinary tract infection ［odds ratio(OR)=2.361,P=0.049］,operation history (OR=2.966,P=0.036),usage of carbapenems (OR=3.396,P=0.018) and production of ESBLs (OR=4.066,P=0.001) were the independent risk factors for IPM-HR-E.coli in bloodstream infections.Conclusion　The incidence of IPM-HR-E.coli in bloodstream infection is relatively high,the emergence of IPM-HR-E.coli was associated with urinary tract infection,operation history,usage of carbapenems and production of ESBLs;fewer invasive operations and reasonable use of antibiotics would be necessary for reducing the emergence of IPM-HR-E.coli strains.

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更新日期/Last Update: 2021-02-05