ICU与非ICU大肠埃希菌的耐药性分析
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摘要
目的了解医院大肠埃希菌(E.coli)感染的临床分布和耐药分析,为临床合理性用药提供依据。方法 1911株E.coli,其中重症监护病房(ICU) 414株,非ICU 1497株。应用法国生物梅里埃全自动微生物鉴定仪进行鉴定,并做临床常用抗菌药物的耐药性分析。结果 (1) E.coli分布:共分离出E.coli1911株,其中ICU分离出414株(21.66%),非ICU分离出1497株(78.34%)。(2)标本分布:其中尿液标本最多,占38.40%(734/1911),其次痰液18.90%(361/1911)、分泌物15.60%(298/1911)、血液12.56%(240/1911)、脓液5.18%(99/1911)、腹水3.61%(69/1911)、胆汁2.77%(53/1911)、穿刺液1.57%(30/1911)、其他0.78%(15/1911)、胸水0.63%(12/1911)。(3) E.coli的药敏试验结果 :1911株E.coli对抗生素厄他培南、亚胺培南、美罗培南等抗菌药物的耐药率较低, ICU分别为3.62%(15/414)、2.42%(10/414)、2.17%(9/414),非ICU分别为1.67%(25/1497)、0.73%(11/1497)、0.87%(13/1497),而对其他抗生素均有较高的耐药率;ICU与非ICU的厄他培南、亚胺培南、美罗培南等抗菌药物的耐药率比较差异均具有统计学意义(P<0.05)。结论与非ICU比较, ICU中检出的E.coli具有较高的耐药率;临床应合理选用抗菌药物,积极采取各种医疗手段,防止耐药的E.coli(尤其是ICU)在院内的播撒。
Objective To understand the clinical distribution and drug resistance of Escherichia coli(E. coli) infection in hospitals, and to provide basis for the reasonable clinical of antibiotics. Methods 1911 strains of E.coli, including 414 strains of intensive care unit(ICU), 1497 strains of non-ICU, were selected. The identification was carried out by using the French biology-biomerieux bacterial automatic identification system and the resistance analysis of commonly used antimicrobial agents in clinic was performed. Results(1) Distribution of E. coli: A total of 1911 strains of E. coli were isolated. 414 strains(21.66%) were isolated from ICU and 1497 strains(78.34%) were isolated from non-ICU.(2) Distribution of specimens: urine specimens accounted for 38.40%(734/1911), sputum specimens accounted for 18.90%(361/1911), secretion specimens accounted for 15.60%(298/1911), blood specimens accounted for 12.56%(240/1911), pus specimens accounted for 5.18%(99/1911), ascites specimens accounted for 3.61%(69/1911), bile specimens accounted for 2.77%(53/1911), puncture fluid specimens accounted for 1.57%(30/1911), the other specimens accounted for 0.78%(15/1911) and pleural effusion specimens accounted for 0.63%(12/1911).(3) Drug susceptibility test of E. coli showed that the drug resistance rate of 1911 strains of E. coli to antibiotics such as Ertapenem, Imipenem and Meropenem were low, in ICU were 3.62%(15/414), 2.42%(10/414) and 2.17%(9/414) respectively, in non-ICU were 1.67%(25/1497), 0.73%(11/1497) and 0.87%(13/1497) respectively, the resistance rates to other antibiotics were high. There were significant differences in drug resistance rates of Ertapenem, Imipenem and Meropenem between ICU and nonICU groups(P<0.05). Conclusion Compared with the non-ICU, detection of E.coli in the ICU has high resistance. It is suggested to choice the reasonable antibiotics, take all kinds of medical treatment and prevent the spread of drug resistance E.coli(especially ICU).
Objective To understand the clinical distribution and drug resistance of Escherichia coli(E. coli) infection in hospitals, and to provide basis for the reasonable clinical of antibiotics. Methods 1911 strains of E.coli, including 414 strains of intensive care unit(ICU), 1497 strains of non-ICU, were selected. The identification was carried out by using the French biology-biomerieux bacterial automatic identification system and the resistance analysis of commonly used antimicrobial agents in clinic was performed. Results(1) Distribution of E. coli: A total of 1911 strains of E. coli were isolated. 414 strains(21.66%) were isolated from ICU and 1497 strains(78.34%) were isolated from non-ICU.(2) Distribution of specimens: urine specimens accounted for 38.40%(734/1911), sputum specimens accounted for 18.90%(361/1911), secretion specimens accounted for 15.60%(298/1911), blood specimens accounted for 12.56%(240/1911), pus specimens accounted for 5.18%(99/1911), ascites specimens accounted for 3.61%(69/1911), bile specimens accounted for 2.77%(53/1911), puncture fluid specimens accounted for 1.57%(30/1911), the other specimens accounted for 0.78%(15/1911) and pleural effusion specimens accounted for 0.63%(12/1911).(3) Drug susceptibility test of E. coli showed that the drug resistance rate of 1911 strains of E. coli to antibiotics such as Ertapenem, Imipenem and Meropenem were low, in ICU were 3.62%(15/414), 2.42%(10/414) and 2.17%(9/414) respectively, in non-ICU were 1.67%(25/1497), 0.73%(11/1497) and 0.87%(13/1497) respectively, the resistance rates to other antibiotics were high. There were significant differences in drug resistance rates of Ertapenem, Imipenem and Meropenem between ICU and nonICU groups(P<0.05). Conclusion Compared with the non-ICU, detection of E.coli in the ICU has high resistance. It is suggested to choice the reasonable antibiotics, take all kinds of medical treatment and prevent the spread of drug resistance E.coli(especially ICU).
引文
[1]孙云婷,王和,杨怀,等.医院感染大肠埃希菌临床分布及耐药性研究.中国消毒学杂志, 2015, 32(3):243-246.
[2]张恩,李霞,谢服煜,等. 2011年-2013年宁波市大肠埃希菌的临床分布与耐药性分析.中国卫生检验杂志, 2015, 25(2):292-294.
[3]冯莉. 223株大肠埃希菌的耐药性分析及分布.中华实验和临床感染病杂志(电子版), 2014, 8(3):424-426.
[4]姜梅杰,李厚景,赵书平.院内大肠埃希菌耐药性分析及分布.中华实验和临床感染病杂志(电子版), 2014, 8(2):62-64.
[5]高玉红,李丰良.重症监护室革兰阴性杆菌分布及耐药性分析.重庆医学, 2014, 43(32):4369-4372.
[6]杜静,龙继川,李春辉.基层医院ICU与非ICU主要革兰阴性杆菌分布与耐药性差异.中国感染控制杂志, 2015, 14(7):468-471.
[7]屈玲,柴婷婷,艾芳.产超广谱β-内酰胺酶大肠埃希菌分布及耐药性分析.现代中西医结合杂志, 2014, 23(7):771-772.
[8]王亚华,祝永明,邵平阳,等.产ESBLs大肠埃希菌的耐药性分析.中华医院感染学杂志, 2015, 25(6):1221-1223.
[9]刘水桂,季苏萍.医院感染产ESBLs大肠埃希菌耐药性分析.中国消毒学杂志, 2014, 31(6):645-646.
[10]麦叶,何振扬,吴远怡,等. ICU患者医院获得性感染的病原菌分布与耐药性分析.中华医院感染学杂志, 2015, 25(13):2932-2934.
[11]张小江,郑波,吕媛,等. 2012年度全国三级医院重症监护病房来源细菌耐药分析.中国临床药理学杂志, 2015, 31(11):970-975.
[12]刘文生,温晓娜,张健东. 2007-2011年ICU患者感染病原菌的分布及耐药性分析.中华医院感染学杂志, 2014, 24(31):565-567.
[13]周红岩,郑媛媛,张红岩,等.重症监护病房常见病原菌的分布及耐药性分析.中国微生态学杂志, 2015, 27(5):588-592.
[2]张恩,李霞,谢服煜,等. 2011年-2013年宁波市大肠埃希菌的临床分布与耐药性分析.中国卫生检验杂志, 2015, 25(2):292-294.
[3]冯莉. 223株大肠埃希菌的耐药性分析及分布.中华实验和临床感染病杂志(电子版), 2014, 8(3):424-426.
[4]姜梅杰,李厚景,赵书平.院内大肠埃希菌耐药性分析及分布.中华实验和临床感染病杂志(电子版), 2014, 8(2):62-64.
[5]高玉红,李丰良.重症监护室革兰阴性杆菌分布及耐药性分析.重庆医学, 2014, 43(32):4369-4372.
[6]杜静,龙继川,李春辉.基层医院ICU与非ICU主要革兰阴性杆菌分布与耐药性差异.中国感染控制杂志, 2015, 14(7):468-471.
[7]屈玲,柴婷婷,艾芳.产超广谱β-内酰胺酶大肠埃希菌分布及耐药性分析.现代中西医结合杂志, 2014, 23(7):771-772.
[8]王亚华,祝永明,邵平阳,等.产ESBLs大肠埃希菌的耐药性分析.中华医院感染学杂志, 2015, 25(6):1221-1223.
[9]刘水桂,季苏萍.医院感染产ESBLs大肠埃希菌耐药性分析.中国消毒学杂志, 2014, 31(6):645-646.
[10]麦叶,何振扬,吴远怡,等. ICU患者医院获得性感染的病原菌分布与耐药性分析.中华医院感染学杂志, 2015, 25(13):2932-2934.
[11]张小江,郑波,吕媛,等. 2012年度全国三级医院重症监护病房来源细菌耐药分析.中国临床药理学杂志, 2015, 31(11):970-975.
[12]刘文生,温晓娜,张健东. 2007-2011年ICU患者感染病原菌的分布及耐药性分析.中华医院感染学杂志, 2014, 24(31):565-567.
[13]周红岩,郑媛媛,张红岩,等.重症监护病房常见病原菌的分布及耐药性分析.中国微生态学杂志, 2015, 27(5):588-592.