社区与医院血流感染大肠埃希菌耐药特征及临床分析

发布时间：2018-11-23 21:17

【摘要】：目的：血流感染具有临床症状重、死亡率高的特征。本研究检测昆明医科大学第二附属医院血流感染大肠埃希菌耐药特性及耐药基因构成并对分布情况进行分析；探讨社区与医院血流感染中产ESBLs大肠埃希菌临床流行病学情况,并对产ESBLs大肠埃希菌引起血流感染的危险因素进行分析。方法：收集昆明医科大学第二附属医院2014年1-12月血流感染中大肠埃希菌181株,其中社区感染88株,医院感染93株。采用法国梅里埃VITEK-2 Compact仪器进行细菌鉴定和药物敏感试验；采用K-B纸片扩散法检测产ESBLs大肠埃希菌；对ESBLs阳性菌株CTX, TEM和SHV基因进行PCR扩增,明确基因分型情况。通过临床病历资料收集,采用SP13.0软件对其引起血流感染的危险因素进行分析。结果：1、181株血流感染大肠埃希菌耐药率均低于10%的有头孢哌酮／舒巴坦、哌拉西林／他唑巴坦、厄他培南、亚胺培南、阿米卡星,医院感染菌株耐药率普遍高于社区感染菌株。社区血流感染产ESBLs大肠埃希菌检出47株,阳性率为53.4%,医院血流感染产ESBLs大肠埃希菌检出68株,阳性率为73.1%,社区感染显著低于医院感染(P=0.006)。2、115株产ESBLs大肠埃希菌中均扩增出CTX型基因占95%,其中CTX-M-1占35%、CTX-M-9占63%；TEM型占53%；SHV型占15%。同时携带2种基因的有58株占50.4%,同时携带3种基因的有13株占11.3%。3、在全院血流感染ESBLs大肠埃希菌检出率前三位科室为ICU、泌尿外科和普外科,其中社区感染占57.4%,医院感染64.7%。6项临床危险因素观察指标中,4项指标结果有显著差异,具有统计学意义,分别为近3个月是否入住医疗机构、是否使用抗生素、是否留置导管及是否机械通气。结论：1、昆明医科大学第二附属医院社区血流感染大肠埃希菌耐药率普遍低于医院感染。2、产ESBLs大肠埃希菌流行基因型主要为CTX型,其次为TEM型和SHV型。3、ICU、泌尿外科、普外科患者血流感染产ESBLs大肠埃希菌阳性率高于其他科室,产ESBLs大肠埃希血流感染可能与医疗机构入住、使用抗生素和侵入性操作等因素有关。故加强医院感染控制,规范侵入性操作,提高医患人员的无菌意识及手卫生,合理使用抗生素,加强ICU、泌尿外科等病房的感染监测是控制细菌耐药性产生的有效措施。
[Abstract]:Objective: blood flow infection is characterized by severe clinical symptoms and high mortality. The drug resistance characteristics of Escherichia coli in the second affiliated hospital of Kunming Medical University and the composition of drug resistance gene were detected and the distribution was analyzed. To investigate the clinical epidemiology of ESBLs Escherichia coli in community and hospital, and to analyze the risk factors of blood stream infection caused by ESBLs producing Escherichia coli. Methods: 181 strains of Escherichia coli from January to December 2014 in the second affiliated Hospital of Kunming Medical University were collected, including 88 strains of community infection and 93 strains of nosocomial infection. The bacteria identification and drug sensitivity test were carried out by using the Merier VITEK-2 Compact instrument in France, the ESBLs producing Escherichia coli was detected by K-B disk diffusion method, and the CTX, TEM and SHV genes of ESBLs positive strains were amplified by PCR to determine the genotyping. The risk factors of blood flow infection were analyzed by SP13.0 software. Results: the drug resistance rates of 1181 blood stream infected Escherichia coli strains were less than 10%, including cefoperazone / sulbactam, piperacillin / tazobactam, etapenem, imipenem, amikacin, etc. The drug resistance rate of nosocomial infection strains was higher than that of community infection strains. 47 strains of ESBLs producing Escherichia coli were detected from community blood flow infection, the positive rate was 53.4%, and 68 strains from hospital blood stream infection produced ESBLs Escherichia coli, the positive rate was 73.1%. Community infection was significantly lower than nosocomial infection (P0. 006). In 2115 strains of ESBLs producing Escherichia coli, 95% of the CTX genes were amplified, of which CTX-M-1 accounted for 35% and CTX-M-9 accounted for 63%. The TEM type was 53% and the SHV type was 15%. There were 58 strains (50.4%) carrying two genes and 13 strains (11.3.3%) carrying three genes simultaneously. ICU, urology and general surgery were the first three departments in the detection rate of ESBLs Escherichia coli infection in the whole hospital. Among them, 57.4% were community infection, 64.7.6 clinical risk factors were observed in hospital infection, and there were significant differences among the four indexes, which were whether or not they were admitted to medical institutions in the last 3 months. Do you use antibiotics, catheters, and mechanical ventilation? Conclusion: 1. The drug resistance rate of Escherichia coli in community blood stream infection of the second affiliated hospital of Kunming Medical University was generally lower than that of nosocomial infection. 2. The prevalent genotype of ESBLs producing Escherichia coli was CTX, followed by TEM and SHV. The positive rate of ESBLs producing Escherichia coli in patients with blood flow infection in urology and general surgery was higher than that in other departments. The infection of ESBLs might be related to the medical institutions, antibiotics use and invasive operation and so on. Therefore, strengthening hospital infection control, standardizing invasive operation, improving staff's aseptic consciousness and hand hygiene, rational use of antibiotics, and strengthening infection monitoring in ICU, urology ward are effective measures to control bacterial drug resistance.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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