医院感染产ESBLs大肠埃希菌的耐药性及危险因素的logistic回归分析

目的 研究某三级甲等医院院内感染产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的耐药性及危险因素，为临床合理使用抗菌药物及医院感染的防控提供依据。方法 采用回顾性病例对照研究，调查2016年1月1日至2018年12月31日期间全院检出产ESBLs大肠埃希菌院内感染患者共550例，对照组则为随机抽取同等数量同期分离的非医院感染产ESBLs大肠埃希菌病例，危险因素分析采用单因素〖XC小五号.EPS;P〗检验和多因素logistic回归分析。结果 共检出医院感染产ESBLs大肠埃希菌病例550例，其中男性325例，女性225例，平均年龄为59.30±20.71岁。耐药率除碳青霉烯类抗菌药物外，医院感染产ESBLs大肠埃希菌均高于对照组。产ESBLs大肠埃希菌医院感染的主要危险因素有:年龄（OR=1.163，95%CI:1.021~1.325，P<0.001）、住院天数（OR=1.789，95%CI:1.455~2.199，P<0.001）、手术（OR=4.436，95%CI:3.249~6.057，P<0.001）、基础疾病（OR=2.124，95%CI:1.562~2.888，P<0.001）和侵入性操作（OR=3.607，95%CI:2.667~4.879，P<0.001）。结论 除碳青霉烯类抗菌药物外，医院感染产ESBLs大肠埃希菌的耐药率均高于非医院感染产ESBLs大肠埃希菌；年龄、住院天数、手术、基础疾病和侵入性操是其主要危险因素。重点监测高危人群，规范抗菌药物的合理使用，将有利于指导院内感染该菌的预防与控制。

Drug resistance of nosocomial infections with ESBLs Escherichia coli and logistic regression analysis of influencing factors

Objective To investigate the drug resistance and risk factors of nosocomial infections with Escherichia coli producing an ultra-broad spectrum of beta-lactamase in the grade III, class A hospital, and to provide evidence for clinical rational drug use and nosocomial infection prevention and control. Methods Case control study was used to 550 cases of ESBLs Escherichia coli infection detected in the hospital from January 1, 2016 to December 31, 2018. Through random sampling, the same number of non-hospital ESBLs escoli cases isolated during the same period were selected as the control group, and the risk factors were analyzed by univariate and mult-ivariate logistic regression. Results A total of 550 cases of ESBLs Escherichia coli infection were detected, including 325 males and 225 females with an average age of 59.30±20.707 years. The drug resistance rate of nosocomial infections with ESBLs Escherichia coli was higher than that of control group except carbapenems. Age(OR=1.163, 95%CI 1.021～1.325, P=0.023), length of stay(OR=1.789, 95%CI 1.455～2.199, P<0.001),surgery(OR=4.436, 95%CI 3.249～6.057, P<0.001),underlying disease(OR=2.124, 95%CI 1.562～2.888, P<0.001)and invasive procedures(OR=3.607,95%CI 2.667～4.879,P<0.001)were major risk factors for nosocomial infections with ESBLs Escherichia coli. Conclusions The drug resistance rate is higher than that of non-nosocomial Escherichia coli except carbapenems, and the major risk factors for nosocomial esbls-producing Escherichia coli include age, length of stay in hospital, surgery, basic disease and invasive operation. Therefore, it is beneficial to the prevention and control of nosocomial infection of this bacterium to focus on monitoring high-risk groups and regulate the rational use of antibiotics.