亚胺培南异质性耐药阴沟肠杆菌的临床特征和感染危险因素调查(1)
[摘要] 目的 探究亞胺培南异质性耐药阴沟肠杆菌的临床特征和感染危险因素。 方法 采用病例对照研究，收集2014年1月～2016年12月重庆医科大学附属第一医院住院患者无菌体液标本中分离的非重复阴沟肠杆菌138株，其中阴沟肠杆菌亚胺培南异质性耐药菌株作为实验组(115株)，非异质性耐药菌株作为对照组(23株)。采用K-B法进行异质性耐药初筛，PAP试验对异质性耐药现象加以确认，并用统计学方法对患者病例资料进行危险因素分析。 结果 收集标本中有115株(83.3%)阴沟肠杆菌对亚胺培南产生异质性耐药现象：从送检科室看，肝胆外科科室分离率最高为34.1%;从分离的标本类型看，多数来源于血液标本，分离率为35.5%。多因素分析结果显示：男性(OR = 3.40，95%CI：1.16～9.92)、导尿管(OR = 3.74，95%CI：1.25～11.24)、中心静脉置管(OR = 3.65，95%CI：1.22～10.89)以及碳青霉烯类抗生素使用(OR = 6.79，95%CI：1.48～31.14)是引起亚胺培南异质性耐药阴沟肠杆菌相关感染的独立危险因素(P < 0.05)。 结论 临床应严格把握抗菌药物的适应证，规范侵入性操作，从而减少耐药菌的出现和流行。
[关键词] 阴沟肠杆菌;亚胺培南;异质性耐药;危险因素
[中图分类号] R378 [文献标识码] A [文章编号] 1673-7210(2019)06(a)-0147-04
Study on clinical characteristics and risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae
ZHOU Yanjun1 JIA Xiaojiong1 HE Jianchun1 XIA Yun2
1.The First Clinical College of Chongqing Medical University， Chongqing 400016， China; 2.Department of Laboratory， the First Affiliated Hospital of Chongqing Medical University， Chongqing 400016， China
[Abstract] Objective To investigate clinical characteristics and risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae. Methods By means of case-control study， a total of 138 strains of Enterobacter cloacae isolated from the aseptic fluid samples of hospitalized patients from the First Affiliated Hospital of Chongqing Medical University from January 2014 to December 2016 were collected. Imipenem-resistant strains of Enterobacter cloacae were used as experimental group (115 strains) and non-heterogeneous drug-resistant strains as control group (23 strains). The disk diffusion was used for screening heteroresistance and PAP test confirmed the heteroresistance. The risk factors of patients'case data were analyzed by statistical method. Results There were 115 strains (83.3%) showed heteroresistance to imipenem. The rate of separation of hepatobiliary department was 34.1%. From the type of isolated specimens， most of them were derived from blood samples and the isolation rate was 35.5%. The results of multivariate analysis showed that male (OR = 3.40， 95%CI： 1.16-9.92)， catheter (OR = 3.74， 95%CI： 1.25-11.24)， central venous catheter (OR = 3.65， 95%CI： 1.22-10.89) and use of carbapenem antibiotics (OR = 6.79， 95%CI： 1.48-31.14) were independent risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae (P < 0.05). Conclusion Clinical indications for antimicrobial agents should be strictly controlled and invasive procedures should be regulated to reduce the emergence and prevalence of heteroresistant bacteria., http://www.100md.com(周妍君 贾晓炯 何建春 夏云)
[关键词] 阴沟肠杆菌;亚胺培南;异质性耐药;危险因素
[中图分类号] R378 [文献标识码] A [文章编号] 1673-7210(2019)06(a)-0147-04
Study on clinical characteristics and risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae
ZHOU Yanjun1 JIA Xiaojiong1 HE Jianchun1 XIA Yun2
1.The First Clinical College of Chongqing Medical University， Chongqing 400016， China; 2.Department of Laboratory， the First Affiliated Hospital of Chongqing Medical University， Chongqing 400016， China
[Abstract] Objective To investigate clinical characteristics and risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae. Methods By means of case-control study， a total of 138 strains of Enterobacter cloacae isolated from the aseptic fluid samples of hospitalized patients from the First Affiliated Hospital of Chongqing Medical University from January 2014 to December 2016 were collected. Imipenem-resistant strains of Enterobacter cloacae were used as experimental group (115 strains) and non-heterogeneous drug-resistant strains as control group (23 strains). The disk diffusion was used for screening heteroresistance and PAP test confirmed the heteroresistance. The risk factors of patients'case data were analyzed by statistical method. Results There were 115 strains (83.3%) showed heteroresistance to imipenem. The rate of separation of hepatobiliary department was 34.1%. From the type of isolated specimens， most of them were derived from blood samples and the isolation rate was 35.5%. The results of multivariate analysis showed that male (OR = 3.40， 95%CI： 1.16-9.92)， catheter (OR = 3.74， 95%CI： 1.25-11.24)， central venous catheter (OR = 3.65， 95%CI： 1.22-10.89) and use of carbapenem antibiotics (OR = 6.79， 95%CI： 1.48-31.14) were independent risk factors for infection of Imipenem-heteroresistant Enterobacter cloacae (P < 0.05). Conclusion Clinical indications for antimicrobial agents should be strictly controlled and invasive procedures should be regulated to reduce the emergence and prevalence of heteroresistant bacteria., http://www.100md.com(周妍君 贾晓炯 何建春 夏云)