中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2012年
5期
278-282
,共5页
张德忠%饶冠利%吴晓春%张胜荣%周文聪
張德忠%饒冠利%吳曉春%張勝榮%週文聰
장덕충%요관리%오효춘%장성영%주문총
呼吸道感染%β-内酰胺酶类%危险因素%抗药性%抗菌药
呼吸道感染%β-內酰胺酶類%危險因素%抗藥性%抗菌藥
호흡도감염%β-내선알매류%위험인소%항약성%항균약
Respiratory tract infections%beta-Lactamases%Risk factor%Drug resistance%Anti-bacterial agents
目的 探讨产超广谱β-内酰胺酶(ESBLs)细菌的耐药性及其致医院获得性下呼吸道感染的危险因素.方法 选取浙江省青田县人民医院2008年7月-2011年12月ESBLs+菌引起的医院获得性下呼吸道感染病例80例,并按数字表法随机选择同期160例ESBLs菌医院感染者作为对照组.采用单因素分析及多因素Logistic回归分析其危险因素,并使用K-B纸片琼脂扩散法测定其对16种抗菌药物的耐药性.结果 单因素分析发现,住院时间≥10 d,转入院或再次入院,给氧,侵入性操作,使用抗酸剂、糖皮质激素、免疫抑制剂＞7 d,使用第三代头孢菌素,使用氟喹诺酮类药物及联合应用抗菌药物≥3 d与医院获得性下呼吸道ESBLs+菌感染有关.多因素Logistic回归分析发现,给氧(OR=8.613,95％CI:1.870 ～ 39.659)、侵入性操作(OR=5.900,95％ CI:1.885 ～ 18.467)、使用第三代头孢菌素(OR=7.465,95％ CI:2.364 ～ 23.578)、使用氟喹诺酮类药物(OR=4.481,95％ CI:1.197 ～ 16.781),以及联合应用抗菌药物≥3 d(OR=5.346,95％CI:1.717～16.643)是医院获得性下呼吸道ESBLs+菌感染的独立危险因素.ESBLs+大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南、头孢哌酮/他唑巴坦及哌拉西林/他唑巴坦的耐药率较低(＜30.00％),对大部分β-内酰胺类、氨基糖苷类、氟喹诺酮类及磺胺类药物的耐药率较高.结论 医院获得性下呼吸道ESBLs+菌感染主要与医院的侵入性操作及抗菌药物的使用有关,ESBLs+分离株的耐药率较高.
目的 探討產超廣譜β-內酰胺酶(ESBLs)細菌的耐藥性及其緻醫院穫得性下呼吸道感染的危險因素.方法 選取浙江省青田縣人民醫院2008年7月-2011年12月ESBLs+菌引起的醫院穫得性下呼吸道感染病例80例,併按數字錶法隨機選擇同期160例ESBLs菌醫院感染者作為對照組.採用單因素分析及多因素Logistic迴歸分析其危險因素,併使用K-B紙片瓊脂擴散法測定其對16種抗菌藥物的耐藥性.結果 單因素分析髮現,住院時間≥10 d,轉入院或再次入院,給氧,侵入性操作,使用抗痠劑、糖皮質激素、免疫抑製劑＞7 d,使用第三代頭孢菌素,使用氟喹諾酮類藥物及聯閤應用抗菌藥物≥3 d與醫院穫得性下呼吸道ESBLs+菌感染有關.多因素Logistic迴歸分析髮現,給氧(OR=8.613,95％CI:1.870 ～ 39.659)、侵入性操作(OR=5.900,95％ CI:1.885 ～ 18.467)、使用第三代頭孢菌素(OR=7.465,95％ CI:2.364 ～ 23.578)、使用氟喹諾酮類藥物(OR=4.481,95％ CI:1.197 ～ 16.781),以及聯閤應用抗菌藥物≥3 d(OR=5.346,95％CI:1.717～16.643)是醫院穫得性下呼吸道ESBLs+菌感染的獨立危險因素.ESBLs+大腸埃希菌和肺炎剋雷伯菌對亞胺培南、美囉培南、頭孢哌酮/他唑巴坦及哌拉西林/他唑巴坦的耐藥率較低(＜30.00％),對大部分β-內酰胺類、氨基糖苷類、氟喹諾酮類及磺胺類藥物的耐藥率較高.結論 醫院穫得性下呼吸道ESBLs+菌感染主要與醫院的侵入性操作及抗菌藥物的使用有關,ESBLs+分離株的耐藥率較高.
목적 탐토산초엄보β-내선알매(ESBLs)세균적내약성급기치의원획득성하호흡도감염적위험인소.방법 선취절강성청전현인민의원2008년7월-2011년12월ESBLs+균인기적의원획득성하호흡도감염병례80례,병안수자표법수궤선택동기160례ESBLs균의원감염자작위대조조.채용단인소분석급다인소Logistic회귀분석기위험인소,병사용K-B지편경지확산법측정기대16충항균약물적내약성.결과 단인소분석발현,주원시간≥10 d,전입원혹재차입원,급양,침입성조작,사용항산제、당피질격소、면역억제제＞7 d,사용제삼대두포균소,사용불규낙동류약물급연합응용항균약물≥3 d여의원획득성하호흡도ESBLs+균감염유관.다인소Logistic회귀분석발현,급양(OR=8.613,95％CI:1.870 ～ 39.659)、침입성조작(OR=5.900,95％ CI:1.885 ～ 18.467)、사용제삼대두포균소(OR=7.465,95％ CI:2.364 ～ 23.578)、사용불규낙동류약물(OR=4.481,95％ CI:1.197 ～ 16.781),이급연합응용항균약물≥3 d(OR=5.346,95％CI:1.717～16.643)시의원획득성하호흡도ESBLs+균감염적독립위험인소.ESBLs+대장애희균화폐염극뢰백균대아알배남、미라배남、두포고동/타서파탄급고랍서림/타서파탄적내약솔교저(＜30.00％),대대부분β-내선알류、안기당감류、불규낙동류급광알류약물적내약솔교고.결론 의원획득성하호흡도ESBLs+균감염주요여의원적침입성조작급항균약물적사용유관,ESBLs+분리주적내약솔교고.
Objective To investigate the antibiotic resistance of extended-spectrum β-lactamases (ESBLs)-producing bacteria,and the risk factors for patients with hospital-acquired lower respiratory tract infections caused by these bacteria.Methods The clinical data of 80 cases of hospital-acquired lower respiratory tract infections caused by ESBLs + bacteria in the People's Hospital of Qingtian in Zhejiang Province from July 2008 to December 2011 were collected; and 160 cases of nosocomial infection caused by ESBLs- bacteria were randomly selected as controls.Univariate analysis and multivariate logistic regression were used to analyze the risk factors for ESBLs + bacteria infection.The resistance of sixteen antibiotics was detected by K-B method.Results Univariate analysis revealed that the risk factors for nosocomial lower respirator tract infection caused by ESBLs+ bacteria were hospitalization ≥ 10 d,readmission to hospital,oxygen inhalation,invasive operations,using antacid ＞ 7 d,using glucocorticoids ＞ 7 d,using immunosuppressant ＞ 7 d,using third-generation cephalosporins,using fluoroquinolone antibacterials,and the combined use of antibiotics≥3 d.Multivariate logistic regression analysis identified five independent risk faetors:oxygen inhalation (OR =8.613,95％ CI:1.870-39.659),invasive operations (OR =5.900,95％CI:1.885-18.467),using third-generation cephalosporins (OR =7.465,95％ CI:2.364-23.578),using fluoroquinolone antibacterials (OR =4.481,95％ CI:1.197-16.781) and combined use of antibiotics≥3 d (OR =5.346,95％ CI:1.717-16.643).ESBLs + Escherichia coli and Klebsiella pneumoniae strains were sensitive to imipenem,meropenem,cefoperazone /sulbactam and piperacillin/tazobactam (with the resistance rates lower than 30.00％),but were highly resistant to most β-lactam,aminoglycoside,fluoroquinolone and sulfonamide antibacterials.Conclusion ESBLs + isolates were highly resistant to most antibacterials,and hospital-acquired lower respiratory tract infections with ESBLs+ bacteria are mainly related with invasive operations and the use of antibiotics.
