大肠埃希菌所致血流感染的临床特点及其耐药性分析
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摘要
目的探讨血流感染分离的大肠埃希菌耐药性,感染的临床特点、治疗方案及其预后。方法收集2017年1-12月诊断为大肠埃希菌血流感染的住院患者临床资料进行回顾性分析,采用SPSS21.0统计学软件进行数据分析处理。结果131例患者白细胞数(WBC)平均为(12.0±7.9)×109/L,检测94例患者C反应蛋白(CRP)平均为(108.9±76.9)mg/L。131例患者住院时间平均22.2 d,41例(31.3%)合并其他细菌感染。细菌耐药率>50%的抗菌药物有头孢呋辛、头孢唑林、头孢噻肟、头孢曲松、氨苄西林;耐药率<5%的抗菌药物有亚胺培南、厄他培南、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、头孢西丁、阿米卡星。大肠埃希菌血流感染多见于脑血管疾病(34.4%)、肿瘤疾病(26.7%)等患者,常见于重症医学科、泌尿外科等科室。将131例大肠埃希菌血流感染患者分为中青年组(<60岁)和老年组(≥60岁),老年组合并其他部位感染、细菌多重耐药率、脑血管疾病、慢性肾病、糖尿病均高于中青年组,差异有统计学意义(P<0.05)。结论大肠埃希菌血流感染容易合并其他部位及其他菌种的感染。老年患者由于基础疾病多、免疫功能相对低下等原因,更易发生重症感染及复合感染。
Objective To investigate the antimicrobial resistance, clinical features, treatment and prognosis of bloodstream infections caused by Escherichia coli. Methods The clinical data of the inpatients with diagnosis of Escherichia coli bloodstream infection during the period from January to December 2017 were analyzed retrospectively. SPSS 21.0 statistical software was used for data processing and analysis. Results A total of 131 patients were included in this analysis. The mean white blood cell count(WBC) was(12.0±7.9)×10~9/L and C reactive protein(CRP) was(108.9±76.9) mg/L. The average length of hospital stay was22.2 days. Complex bacterial infection was identified in 41(31.3%) patients. More than 50% of the E. coli isolates were resistant to cefuroxime, cefazolin, cefotaxime, ceftriaxone, and ampicillin. Less than 5% of the E. coli isolates were resistant to imipenem,ertapenem, piperacillin-tazobactam, cefoperazone-sulbactam, cefoxitin, and amikacin. E. coli bloodstream infections were more common in the patients with cerebrovascular disease(34.4%), oncological disease(26.7%), or other underlying disease, and more prevalent in ICU and Department of Urology. The 131 cases of E. coli bloodstream infection were analyzed in terms of patient age(<60 or ≥60 years old). The elderly patients were associated with significantly higher proportion of concomitant infection sites,multidrug resistance, underlying cerebrovascular disease, chronic kidney disease or diabetes mellitus compared to younger patients(P<0.05). Conclusions Bloodstream infections caused by E. coli are usually associated with infections in other sites and other pathogens. The elderly patients are more likely to develop severe or complex infections due to more underlying diseases and impaired immune function.
Objective To investigate the antimicrobial resistance, clinical features, treatment and prognosis of bloodstream infections caused by Escherichia coli. Methods The clinical data of the inpatients with diagnosis of Escherichia coli bloodstream infection during the period from January to December 2017 were analyzed retrospectively. SPSS 21.0 statistical software was used for data processing and analysis. Results A total of 131 patients were included in this analysis. The mean white blood cell count(WBC) was(12.0±7.9)×10~9/L and C reactive protein(CRP) was(108.9±76.9) mg/L. The average length of hospital stay was22.2 days. Complex bacterial infection was identified in 41(31.3%) patients. More than 50% of the E. coli isolates were resistant to cefuroxime, cefazolin, cefotaxime, ceftriaxone, and ampicillin. Less than 5% of the E. coli isolates were resistant to imipenem,ertapenem, piperacillin-tazobactam, cefoperazone-sulbactam, cefoxitin, and amikacin. E. coli bloodstream infections were more common in the patients with cerebrovascular disease(34.4%), oncological disease(26.7%), or other underlying disease, and more prevalent in ICU and Department of Urology. The 131 cases of E. coli bloodstream infection were analyzed in terms of patient age(<60 or ≥60 years old). The elderly patients were associated with significantly higher proportion of concomitant infection sites,multidrug resistance, underlying cerebrovascular disease, chronic kidney disease or diabetes mellitus compared to younger patients(P<0.05). Conclusions Bloodstream infections caused by E. coli are usually associated with infections in other sites and other pathogens. The elderly patients are more likely to develop severe or complex infections due to more underlying diseases and impaired immune function.
引文
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[10]何卫平，崔恩博，王钱，等．235株血流感染大肠埃希菌耐药性分析[J]．中国感染控制杂志，2015, 14(3):170-173.
[11]范利红，苗彩云，邵淑容，等．2010-2014年医院大肠埃希菌耐药性变迁与抗菌药物使用频度相关性分析[J]．中华医院感染学杂志，2017, 27(1):20-23.
[12]张顺，黄左安，胡珊珊，等．耐药基因与管家基因的耐碳青霉烯类肺炎克雷伯菌亲缘关系研究[J]．中华医院感染学杂志，2016, 26(3):485-487.
[13] JAPONI-NEJAD A, GGAZNAVI-RAD E, VAN BELKUM A.Characterization of plasmid-mediated AmpC and carbapenemases among Iranain nosocomial isolates of Klebsiella pneumoniae using phenotyping and genotyping methods[J].Osong Public Health Res Perspect, 2014, 5(6):333-338.
[14] SHENG J F, LI J J, TU S, et al. blaKPC and rmtB on a single plasmid in Enterobacter amnigenus and Klebsiella pneumoniae isolates from the same patient[J].Eur J Clin Microbiol Infect Dis, 2012, 31(7):1585-1591.
[2]吕媛，李耘，薛峰，等．卫生部全国细菌耐药监测网（Mohnarin)2011-2012年度血流感染细菌耐药监测报告[J]．中国临床药理学杂志，2014, 30(3):278-288.
[3]李耘，吕媛，郑波，等．中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J]．中国临床药理学杂志，2017, 33(23):2521-2542.
[4]尚红，王毓三，申子瑜.全国临床检验操作规程（第4版）[M].4版.北京：人民卫生出版社，2015:578-593.
[5]余娟娟，王秀华，王曲芳．某中医医院大肠埃希菌血流感染临床特征及耐药性分析[J]．中国消毒学杂志，2017, 34(5):465-467.
[6]王钱，鲍春梅，何卫平，等．老年肝胆疾病患者大肠埃希菌血流感染的临床特点分析[J]．临床肝胆病杂志，2015, 31(5):762-765.
[7] LAUPLAND K B.Incidence of bloodstream infection:a review of population-based studies[J].Clin Microbiol Infect,2013, 19(6):492-500.
[8] ANDRADE L N, VITALI L, GASPAR G G, et al. Expansion and evolution of a virulent, extensively drug-resistant(polymyxin B-resistant), QnrS1-, CTX-M-2-, and KPC-2-producing Klebsiella pneumoniae ST11 international high-risk clone[J].J Clin Microbiol, 2014, 52(7):2530-2535.
[9] LEE C R, LEE J H, PARK K S, et al.Global dissemination of carbapenemase-producing Klebsiella pneumoniae:epidemiology, genetic context, treatment options, and detection methods[J].Front Microbiol, 2016, 7:895.
[10]何卫平，崔恩博，王钱，等．235株血流感染大肠埃希菌耐药性分析[J]．中国感染控制杂志，2015, 14(3):170-173.
[11]范利红，苗彩云，邵淑容，等．2010-2014年医院大肠埃希菌耐药性变迁与抗菌药物使用频度相关性分析[J]．中华医院感染学杂志，2017, 27(1):20-23.
[12]张顺，黄左安，胡珊珊，等．耐药基因与管家基因的耐碳青霉烯类肺炎克雷伯菌亲缘关系研究[J]．中华医院感染学杂志，2016, 26(3):485-487.
[13] JAPONI-NEJAD A, GGAZNAVI-RAD E, VAN BELKUM A.Characterization of plasmid-mediated AmpC and carbapenemases among Iranain nosocomial isolates of Klebsiella pneumoniae using phenotyping and genotyping methods[J].Osong Public Health Res Perspect, 2014, 5(6):333-338.
[14] SHENG J F, LI J J, TU S, et al. blaKPC and rmtB on a single plasmid in Enterobacter amnigenus and Klebsiella pneumoniae isolates from the same patient[J].Eur J Clin Microbiol Infect Dis, 2012, 31(7):1585-1591.