ICU产超广谱β-内酰胺酶细菌医院感染危险因素及耐药性分析

目的探讨ICU产超广谱β-内酰胺酶(ESBLs)细菌医院获得性感染的危险因素及其耐药性,为其防治提供依据。方法采用病例对照研究,收集医院ICU 2006年8月~2009年6月ESBLs细菌引起的医院获得性感染病例63例,并随机选择同时期126例ESBLs阴性菌医院感染作为对照组,采用单因素分析及多因素Logistic回归分析其危险因素,并使用K-B纸片琼脂扩散法测定其对15种抗菌药物的耐药性。结果单因素分析发现,入住ICU时间≥15 d、侵入性操作、长期使用三代头孢、氟喹诺酮类抗菌药物、抗酸剂及使用激素与ESBLs菌医院感染有关;多因素Logistic回归分析发现,ICU住院≥15 d(OR=1.981,95%CI1.009~3.891)、侵入性操作(OR=4.474,95%CI1.863~10.742)、使用三代头孢(OR=2.443,95%CI1.187~5.028)和氟喹诺酮类抗菌药物(OR=2.448,95%CI1.056~5.677)是独立危险因素;ESBLs菌对亚胺培南、美罗培南、头孢哌酮/他唑巴坦及哌拉西林/他唑巴坦的耐药率均25.0%,其余12种抗菌药物的耐药率均38.0%。结论产ESBLs菌耐药率高,应根据危险因素采取有效措施减少ICU患者ESBLs菌的感染。

Nosocomial Infection due to Extended-spectrum β-Lactamases Bacteria in Intensive Care Units: Drug Resistance and Risk Factors

OBJECTIVE To investigate the risk factors for nosocomial infection caused by extended-spectrum β-lactamases-producing bacteria in ICU and discuss how to control infection.METHODS By a case control study,the data of 63 cases of nosocomial infection caused by ESBLs-producing bacteria from Aug 2006 to Jun 2009 in ICU of our hospital were analyzed.As a control the 126 cases of nosocomial infection caused by ESBLs-negative bacteria were selected randomly,at the same time univariate analysis and multivariate Logistic regression were used for statistics analysis and drug resistance to sixteen antibiotics was also detected by K-B method.RESULTS Univariate analysis revealed that six factors associated with the infection caused by ESBLs-producing bacteria were ICU stay time≥15d,invasive operation,antacid and glucoeorticoid,and using the third-generation cephalosporins and fluoroquinolone antibacterials,respectively.Multivariate Logistic regression analysis identified four independent factors as ICU stay time≥15 d(OR=1.981,95%CI1.009-3.891),invasive operation(OR=4.474,95%CI 1.863-10.742),using the third-generation cephalosporins(OR=2.443,95%CI 1.187-5.028)and fluoroquinolone antibacterial(OR=2.448,95%CI 1.056～5.677).Otherwise,the ESBLs-producing strains was sensitive to imipenem and meropenem,and their resistance rates to imipenem,meropenem,cefoperazone/sulbactam and piperacillin/tazobactam were lower than 25.0%,but higher than 38.0%to 12 kinds of other antibiotics.CONCLUSIONS The drug-resistant rate is much higher in ESBLs-producing strains,the effective strategies and measures should be carried out to reduce the infection of ESBLs-producing bacteria in ICU.