血流感染中头孢吡肟异质性耐药大肠埃希菌的流行病学分析

目的 了解血流感染中头孢吡肟异质性耐药大肠埃希菌的流行病学情况.方法 回顾性收集该院2015年1月至2018年12月血流感染中分离的248株大肠埃希菌,并将其分为头孢吡肟耐药组 、头孢吡肟异质性耐药组和头孢吡肟敏感组.异质性耐药表型确认通过K-B法和菌落谱型分析实验完成,采用脉冲场凝胶电泳(PFGE)和PCR进行菌株同...

Epidemiological analysis of cefepime heterogeneous resistance Escherichia coli in bloodstream infection

Objective To understand the epidemiology of cefepime heterogeneous resistance Escherichia coli in bloodstream infections.Methods A retrospective collection of 248 strains of Escherichia coli isolated from bloodstream infections in the hospital from January 2015 to December 2018 were divided into cefepime resistant group,cefepime heterogeneous resistance group and cefepime sensitive group.The confirmation of heterogeneous drug resistance phenotype was completed by K-B method and population analysis profile experiment,pulse field gel electrophoresis(PFGE)and PCR were used to complete strain homology analysis and drug resistance gene detection,and risk factor analysis was conducted through double case control.Results Among the 248 strains,the heterogeneous resistance rate of Escherichia coli to cefepime was 31.5%.PFGE results show that there was no homologous transmission among heterogeneous resistant strains.PCR results showed that the heterogeneous resistant strains mainly expressed blaCTX-M,accounting for 71.9%.Multivariate Logistic regression analysis showed that compared with cefepime resistant group and cefepime sensitive group,age>60 years old,urinary tract infection,urinary catheter,cephalosporin and ESBLs production were independent risk factors for cefepime resistant Escherichia coli(P<0.05);compared with cefepime resistant group and cefepime heterogeneous resistance group,urinary tract infection and ESBLs production were independent risk factors for cefepime resistant Escherichia coli(P<0.05);compared with cefepime heterogeneous resistance group and cefepime sensitive group,transfer,neutropenia,enema and ESBLs production were independent risk factors for cefepime heterogeneous resistant Escherichia coli.Conclusion The incidence of cefepime heterogeneous resistance Escherichia coli is higher,and ESBLs production is a common independent risk factor for cefepime resistant and heterogeneous resistant Escherichia coli.In order to reduce the prevalence of cefepime heterogeneous resistance Escherichia coli,we can combine the relevant epidemiological data and rational use of various antibiotics.