社区获得性胆道感染细菌多重耐药及危险因素分析

发布时间：2018-10-20 12:58

【摘要】：目的了解社区获得性胆道感染细菌多重耐药的现状及有关危险因素,便于指导临床用药。方法回顾性收集从2014年4月至2016年9月重庆市人民医院三院院区肝胆外科对社区获得性胆道感染患者进行胆汁细菌培养所得146株细菌的药敏试验资料及患者的有关临床资料(年龄、体质指数、是否患糖尿病、是否患高血压、是否患高脂血症、是否患恶性肿瘤、是否曾经住院、是否胆道感染反复发作3次以上、胆道感染部位、是否胆囊肿大/胆总管扩张、是否低蛋白血症、感染细菌种类、入院前90 d内是否使用抗生素、本次胆道感染发作后是否使用抗生素、本次胆道感染发作后是否长时间使用抗生素7 d以上),并对可能的有关因素进行单因素分析和多因数logistic回归分析。结果本研究共发现多重耐药菌株43株,其构成如下:大肠埃希菌72.1%、肺炎克雷伯菌4.7%、阴沟肠杆菌4.7%、其他18.6%。多重耐药总发生率为29.4%(43/146),其中大肠埃希菌60.8%、肺炎克雷伯菌7.1%、阴沟肠杆菌11.8%、其他16.0%。多重耐药的大肠埃希菌对各种抗生素的敏感率从高到低依次如下:阿米卡星100.0%、亚胺培南90.3%、厄他培南90.3%、头孢替坦83.9%、哌拉西林/他唑巴坦77.4%。单因素分析发现年龄(≥60岁)、胆道感染部位(胆管)、胆囊肿大/胆总管扩张、低蛋白血症、胆道感染细菌种类(大肠埃希菌)、本次胆道感染发作后长时间(≥7 d)使用抗生素与胆道多重耐药细菌感染有关(P0.05)。多因数分析发现年龄(≥60岁)、胆道感染细菌种类(大肠埃希菌)、本次发作后长时间(≥7 d)使用抗生素与胆道多重耐药细菌感染有关(P0.05)。结论社区获得性胆道感染多重耐药情况较严重,主要多重耐药菌为大肠埃希菌,对多重耐药大肠埃希菌敏感性较高的抗生素依次为阿米卡星、亚胺培南、厄他培南、头孢替坦和哌拉西林/他唑巴坦。年龄(≥60岁)、感染细菌种类和本次发作后长时间(≥7 d)使用抗生素是胆道细菌多重耐药的危险因素。
[Abstract]:Objective to investigate the present situation and risk factors of multidrug resistance in community acquired biliary tract infection. Methods from April 2014 to September 2016, 146 strains of bacteria were collected from hepatobiliary surgery of the third Hospital of Chongqing people's Hospital. Relevant clinical data (age, Body mass index (BMI), diabetes, hypertension, hyperlipidemia, malignant neoplasms, hospitalization, repeated episodes of biliary tract infection, location of biliary tract infection, cholecystitis / choledochus dilatation, Whether hypoproteinemia, the type of infection bacteria, whether to use antibiotics within 90 days before admission, whether to use antibiotics after the attack of biliary tract infection, Whether to use antibiotics for more than 7 days after the attack of biliary tract infection, and to make univariate analysis and multifactor logistic regression analysis to the possible related factors. Results A total of 43 multidrug resistant strains were found in this study. Their composition was as follows: Escherichia coli 72.1, Klebsiella pneumoniae 4.7, Enterobacter cloacae 4.7and others 18.6. The total incidence of multidrug resistance was 29.4% (43 / 146), among which Escherichia coli was 60.8, Klebsiella pneumoniae 7.1, Enterobacter cloacae 11.8and others 16.0. The susceptibility rates of multidrug resistant Escherichia coli to various antibiotics were as follows: amicacin 100.0, imipenem 90.3, ertapenem 90.3, ceftitan 83.9, piperacillin / tazobactam 77.4. Univariate analysis showed age (鈮，

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