尿路分离大肠埃希菌耐药性及喹诺酮类药物耐药株危险因素病例对照研究

摘要

Objective To analyze the drug resistance of Escherichia coli isolated from urinary tract infection and risk factors of quinolone resistance strains.Methods A total of 705 cases (strains) with Escherichia coli drug resistance isolated from urine specimens were divided into quinolone sensitive group [474 cases(strains)] and quinolone resistance group [231 cases(strains)].The risk factors of the quinolone resistance strains were analyzed.Results The sensitivity rate of amoxicillin/clavulanic acid,cefalotin,ceftazidime,aztreonam,piperacillin,amikacin,compound sulfamethoxazole,ciprofloxacin,gentamicin,levofloxacin,cefepime in quinolone resistance group was higher than that in quinolone sensitive group [50.2％(238/474) vs.78.8％(182/231),11.6％(55/474) vs.48.5％(112/231),17.9％(85/474) vs.63.2％(146/231),15.0％(71/474) vs.57.6％(133/231),3.2％(15/474) vs.27.7％(64/231),80.8％(383/474)vs.93.1％(215/231),16.0％(76/474) vs.49.8％(115/231),0 vs.100.0％(231/231),32.5％ (154/474)vs.70.6％ (163/231),3.8％ (18/474) vs.98.7％ (228/231),18.6％ (88/474) vs.63.2％ (146/231),P ＜0.05].Logistic regression analysis showed history of using the third generation cephalosporins and quinolones,urinary drainage and bacterium producing extra-broad spectrum beta-lactamase was independent risk factor for quinolone resistance Escherichia coli (P ＜ 0.05).Conclusions The epidemic of quinolone resistance Escherichia coli isolated from urine specimens is extremely serious.The quinolone resistance is strong,and infection patients have a high medical cost and average length of stay.The quinolone resistance Escherichia coli infection has multiple independent risk factors.To strengthen the control of the independent risk factors can effectively prevent quinolone resistance strains infection spread.%目的 分析尿路感染大肠埃希菌耐药性及喹诺酮类药物耐药株感染危险因素.方法 监测705例(株)尿路感染大肠埃希菌的耐药性,分为喹诺酮敏感组474例(株)和喹诺酮耐药组231例(株),分析耐药株感染危险因素.结果 喹诺酮耐药组阿莫西林/克拉维酸、头孢噻吩、头孢他啶、氨曲南、哌拉西林、阿米卡星、复方磺胺甲噁唑、环丙沙星、庆大霉素、左氧氟沙星、头孢吡肟的敏感率明显低于喹诺酮敏感组[50.2％ (238/474)比78.8％(182/231)、11.6％ (55/474)比48.5％(112/231)、17.9％(85/474)比63.2％(146/231)、15.0％(71/474)比57.6％(133/231)、3.2％ (15/474)比27.7％(64/231)、80.8％(383/474)比93.1％(215/231)、16.0％(76/474)比49.8％(115/231)、0比100.0％(231/231)、32.5％ (154/474)比70.6％(163/231)、3.8％ (18/474)比98.7％ (228/231)、18.6％ (88/474)比63.2％(146/231),P＜0.05].多因素非条件Logistic回归分析显示,既往使用三代头孢菌素和喹诺酮类药物、尿路引流及产超广谱β-内酰胺酶是喹诺酮类药物耐药株感染的独立危险因素(P＜0.05).结论 尿路感染大肠埃希菌中喹诺酮类药物耐药株的检出率高、耐药性强,患者住院时间长、住院费用高.耐药株感染具有多个危险因素,加强对这些因素的控制有助于预防感染的扩散.