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探讨血流感染中头孢吡肟耐药大肠埃希菌的流行病学特点及感染危险因素,为临床感染预防提供理论依据。收集2014年1月至2015年12月重庆医科大学附属第一医院血流感染标本中的71株头孢吡肟耐药大肠埃希菌作为病例组,同时选取等比例的头孢吡肟敏感大肠埃希菌作为对照组,进行病例对照研究。采用脉冲场凝胶电泳(pulsed-field gel electrophoresis,PFGE)进行分子流行病学调查,并采用卡方检验和logistic回归模型对患者病例资料进行相关危险因素分析。病例组菌株多重耐药现象严重,对喹诺酮类、氨基糖苷类、磺胺类抗生素的耐药率分别为84.5%、64.8%、77.5%,明显高于对照组;PFGE结果显示耐药菌株间不存在克隆传播现象;危险因素分析显示感染前手术史、引流管、头孢菌素类抗生素使用和产ESBLs是其独立危险因素。因此,建议医院加强该类细菌的监管和防控,减少相关侵入性操作,避免滥用抗生素,从而减少头孢吡肟耐药菌株的产生与流行。
To investigate the epidemiological characteristics of cefepime-resistant Escherichia coli in bloodstream infection and the risk factors of infection to provide a theoretical basis for the prevention of clinical infection. A total of 71 cefepime resistant E. coli isolates from the first affiliated hospital of Chongqing Medical University from January 2014 to December 2015 were selected as the case group and the same proportion of cefepime sensitive Escherichia coli Bacteria as a control group, case-control study. The molecular epidemiology was investigated by pulsed-field gel electrophoresis (PFGE). The chi-square test and logistic regression model were used to analyze the risk factors of patients. The multi-drug resistance of the strains in the case group was serious. The resistance rates to quinolones, aminoglycosides and sulfonamides were 84.5%, 64.8% and 77.5%, respectively, which were significantly higher than those in the control group. PFGE results showed that there was no drug- Clonal transmission phenomenon; risk factor analysis showed that preoperative infection history, drainage tube, cephalosporin antibiotics use and ESBLs production is an independent risk factor. Therefore, it is recommended that hospitals should strengthen the supervision and control of such bacteria, reduce the related invasive procedures, avoid the abuse of antibiotics, and reduce the production and prevalence of cefepime resistant strains.