肝硬化患者产超广谱β-内酰胺酶大肠埃希菌菌血症的危险因素及预后相关分析

目的研究肝硬化患者产超广谱β-内酰胺酶（ESBLs）大肠埃希菌菌血症的危险因素以及影响其预后的相关因素。方法采用病例对照设计,回顾性分析解放军第三○二医院2001—2006年30例大肠埃希菌菌血症肝硬化患者的临床资料,同时选择与阳性患者性别、年龄及培养日期最接近的ESBLs阴性大肠埃希菌菌血症肝硬化患者30例作为病例对照。分析患者初次血培养阳性时的基础疾病、体温、白细胞数及中性粒细胞数、抗生素使用情况、临床合并症、免疫抑制治疗、有创操作、住院时间及培养前、后住院时间等;分析患者菌血症预后与抗生素使用的关系。统计处理采用SPSS10.0软件。均数比较采用Student′st检验;计数资料比较采用Fisher精确检验（双边）;如Fisher精确检验相差显著,做比数比和可信区间及M-Hχ^2检验;危险因素相关性分析采用逻辑回归分析。结果预用头孢类抗生素是ESBLs阳性大肠埃希菌菌血症肝硬化患者感染独立危险因素（OR=5.675,χ^2MH=8.076,P=0.004）。不适当抗生素治疗导致感染预后不好（OR=22.000,χ^2MH=6.658,P=0.010）。结论谨慎使用头孢菌素,特别是第三代头孢菌素能够降低产ESBLs大肠埃希菌菌血症的发病率。

Risk factors and prognosis in cirrhotic patients with ESBLs-producing Escherichia coli bacteremia

Objective To identify the risk factors for bloodstream infections caused by extended-spectrum- lactamase （ESBLs）-producing Escherichia coli in cirrhotic patients and the associated clinical outcomes of bacteremia. Methods A retrospective case-control design was performed. Thirty cirrhotics of ESBLs-producing Escherichia coli bacteremia in 302 hospital of PLA were reviewed. Another 30 cirrhotlcs with ESBLs-negtive Escherichia coli bacteremia were selected as control, and were matched to the age, sex, the date of initial culture. Data were collected and analyzed including the demographic characteristics, underlying illness, clinical information on biotic treatment and microbiological data. The characteristics of two group were compared by means of χ^2 or Studen＇s t-tests. A two-tailed Fisherrs exact test was used for comparisons of pharmacological exposure. All results variables having a P value of ≤ 0. 05 were included in logistic regression modeling. The relationship among the above risk factors and ESBLs-producing Escherichia coli bacteremia and clinical outcome of bacteremia were analyzed with univariate analysis and logistic regression by SPSS 10.0. Results Previous cephalosporins treatment was the only independent risk factor for bacteremia due to ESBLs- producing Escherichia coli （OR = 5. 675, χ^2MH = 8. 076, P = 0. 004）. Inappropriate antibiotic treatment was the only independent risk factor for higher mortality rate （OR = 22. 000,χ^2MH = 6. 658, P = 0. 010）. Conclusion More judicious use of cephalosporins, especially 3rd-generation cephalosporins, may decrease ESBLs-producing Escherichia coli baeteremia.