糖尿病患者感染产ESBLs肠杆菌科细菌的耐药性及危险因素分析

目的 了解中山市糖尿病患者感染产超广谱β-内酰胺酶(extended spectrum β-Lactamases,ESBLs)肠杆菌科细菌的耐药性及危险因素。方法 收集2014年1月～2016年6月中山大学附属中山医院120例确诊糖尿病并发感染产ESBLs肠杆菌科细菌患者的临床标本132例和临床资料。通过VTIEK 2 COMPCT全自动微生物鉴定系统进行菌种鉴定和药物敏感试验; 使用VITEK 2 COMPCT高级专家系统判定菌株的耐药表型和耐药模式,同时根据是否产ESBLs,把主要致病菌大肠埃希菌分为ESBLs-positive组和ESBLs-negative组,比较两组在耐药模式之间的区别。对患者的各项临床资料进行logistic回归分析糖尿病并发感染产ESBLs肠杆菌科细菌的危险因素。结果糖尿病患者感染产ESBLs肠杆菌科细菌主要是大肠埃希菌,其次是肺炎克雷伯菌,感染标本来源主要是中段尿。大肠埃希菌和肺炎克雷伯菌对厄他培南和亚胺培南敏感度为100%,对头孢替坦和哌拉西林/他唑巴坦的敏感度大于98%。大肠埃希菌ESBLs-positive组和ESBLs-negative组在获得性青霉素酶、β-内酰胺类抗生素野生型、其他超广谱β-内酰胺酶和CTX-M型ESBLs四种耐药模式之间差异均有统计学意义(χ²=17.34,19.23,33.90,42.75,均P<0.05)。经logistic回归分析,年龄、住院次数、性别、糖尿病病程、收缩压、糖化血红蛋白水平、抗生素使用情况、感染前的治疗情况、类固醇药物应用、外科手术、侵入性操作、并发症等均不是产ESBLs肠杆菌科细菌感染的危险因素。结论 大肠埃希菌和肺炎克雷伯菌是糖尿病患者感染产ESBLs肠杆菌科的主要致病菌,感染部分主要是泌尿系统。产ESBLs肠杆菌对厄他培南、亚胺培南、头孢替坦和哌拉西林/他唑巴坦敏感。大肠埃希菌ESBLs-positive组和ESBLs-negative组主要表现为四种耐药模式的差异。年龄、住院次数和性别等常见因素均不是糖尿病患者感染产ESBLs肠杆菌科细菌的危险因素。

Analysis of the Drug Resistance and Risk Factors of ESBLs-Producing Enterobacteriaceae Infection in Diabetics

Objective To study the drug resistance and riskfactors for ESBLs-producing Enterobacteriaceae infection in diabetics in Zhongshan.Methods 132 strains and clinical data were collected from January 2014 to June 2016 in 120 diabetes with Enterobacteriaceae bacteria infection in the Sun Yat-sen Hospital Affiliated to Sun Yat-sen University.VTIEK 2 COMPCT automatic microbial identification system was used to identify strains and test drug sensitivity.The resistance phenotype and resistancepattern of the strain were determined by VTIEK 2 COMPCT advanced expert system.According to whether ESBLs was produced,the main pathogenic bacteria of Escherichia coli was divided into the ESBLs-positive group and the ESBLs-negative group,then compared the differences between the two groups in drug resistance patterns.Logistic regression was performed to analyze the risk factors for ESBLs-producing Enterobacteriaceae infection in diabetics.ResultsThe main pathogenic bacteria of diabetes patients with ESBLs-producing infection was Escherichia coli,followed by Klebsiella pneumoniae.The main source of infection was middle-stage urine.Escherichia coli andKlebsiella pneumonia bacteria were sensitive to Ertapenem and Imipenem,thesusceptible rate to cefotetan and Piperacillin/Tazobactam was higher than 98%.Four modes of resistances(Acquired penicillinase,Wild-beta-lactam antibiotic,other ESBLs,ESBLs(CTX-M LIKE))had significant differences between the ESBLs-positive and ESBLs-negative groups(χ²=17.34,19.23,33.90,42.75,all P<0.05).Through logistic regression analysis,age,times of hospitalization,sex,diabetes duration,blood pressure,hemoglobin A1c levels,the usage of antibiotics,infection before the treatment and application of steroid andsurgery,invasive operation and complications were not the risk factors of ESBLsinfection.Conclusion Escherichia coli and Klebsiella pneumoniae were the main pathogenic bacterias of ESBLs-producing Enterobacteriaceae in diabetic patients.The infection was mainly in the urinary system.ESBLs-producing Enterobacteriaceae were sensitive to Ertapenem,Imipenem,Cefotetan and Piperacillin/Tazobactam.Four modes of resistances had significant differences between the ESBLs-positive and ESBLs-negative groups.Age,the times of hospitalization,gender and other common factors were not the risk factors of the infection of ESBLs-producing Enterobacteriaceae bacteria in diabetic patients.