肠球菌多重耐药株出现的危险因素和用药探究

目的:了解某院肠球菌感染的临床分布、耐药情况、多重耐药株出现的危险因素及用药情况,为临床肠球菌感染患者抗菌药物的合理用药提供参考依据。方法:对2016年7月-2018年12月检出的肠球菌的标本来源、临床科室分布、药敏结果、患者基础疾病及抗菌药物选择进行回顾性分析。采用χ^2检验对肠球菌属粪肠球菌、屎肠球菌、鸟肠球菌的药敏结果进行比较分析;同时采用Logistics回归分析对多重耐药株进行多因素分析。结果:共分离出151株肠球菌属,检出7种肠球菌,其中以粪肠球菌(53.64%)和屎肠球菌(29.13%)为主;屎肠球菌对氨苄西林、环丙沙星、左氧氟沙星、莫西沙星、呋喃妥因、青霉素的耐药率高于粪肠球菌和鸟肠球菌;屎肠球菌对高单位的庆大霉素耐药率为75%(P=0.000),高于粪肠球菌而低于鸟肠球菌的耐药率;粪肠球菌对奎奴普丁-达福普丁的耐药率96.2%(P=0.000)明显高于屎肠球菌(4.54%)和鸟肠球菌(70%)。对粪肠球菌和鸟肠球菌感染,临床上使用甲磺酸左氧氟沙星氯化钠注射液最多,而对屎肠球菌,使用注射用哌拉西林钠他唑巴坦钠最多。2种及2种以上基础疾病、泌尿道感染、既往3个月内使用过抗菌药物和既往3个月内住院是导致肠球菌感染患者发生多重耐药菌感染的危险因素。结论:屎肠球菌感染在该院肠球菌属感染中占主要地位,耐药率方面明显高于粪肠球菌和鸟肠球菌。针对肠球菌感染的患者,临床医师在经验性选择抗菌药物时,需要考虑以上4种多重耐药菌感染的危险因素。

Investigation of risk factors and medication analysis of multidrug-resistant bacteria Enterococcus infections

OBJECTIVE To investigate the clinical distribution, drug resistance, risk factors of multi-drug resistant strains and medication of enterococcal infection in a hospital, and to provide reference for rational use of antibiotics in patients with clinical enterococcal infection.METHODS The samples of Enterococcus detected from July 2016 to December 2018, including source of samples, distribution in clinical departments, drug sensitivity results, patients' underlying diseases and selection of antibiotics were analyzed retrospectively.χ² test was used to compare the susceptibility results of Enterococcus faecalis, Enterococcus faecium, and Enterococcus avium.Meanwhile, logistic regression analysis was used to perform multivariate analysis of multidrug-resistant strains.RESULTS A total of 151 Enterococcus strains were isolated, including 7 kinds of Enterococcus strains, of which Enterococcus faecalis (53.64%) and Enterococcus faecium (29.13%) were predominant; The resistance rates of Enterococcus faecium to ampicillin, ciprofloxacin, levofloxacin, nitrofurantoin, nitrofurantoin and penicillin were higher than those of Enterococcus faecalis and Enterococcus avium. The resistance rate of Enterococcus faecium to gentamicin (high concentration) was 75%, which was higher than that of Enterococcus faecalis while lower than that of Enterococcus avium. The resistance rate of Enterococcus faecalis to quinupristin-dalfopristin was 96.2% (P=0.000), which was higher than that of Enterococcus faecium (4.54%) and Enterococcus avium (70%). For Enterococcus faecalis and Enterococcus avium infections, levofloxacin mesylate and sodium chloride injection is most commonly used, while for Enterococcus faecium, piperacillin sodium and tazobactam sodium for injection is most commonly used. ≥ 2 underlying diseases, urinary tract infection, use of antimicrobial agents within three months, and hospitalization within three months were risk factors for the development of multidrug-resistant bacterial infections in patients with enterococcal infections.CONCLUSION Enterococcus faecium infection is the main infection of Enterococcus in the hospital, and the drug resistance rate is higher than that of Enterococcus faecalis and Enterococcus avium.For patients with enterococcal infections, clinicians need to consider the risk factors for infection with the above four multidrug-resistant bacteria when empirically selecting antimicrobial agents.