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为了探究血流感染中耐三代头孢大肠埃希菌(third-generation-cephalosporin-resistant Escherichia coli,3GCREco)的分子流行病学特点及感染危险因素,最终为临床用药和感染防控提供理论依据,我们在重庆医科大学附属第一医院2013年1月至2015年12月期间,选取了120例耐三代头孢大肠埃希菌血流感染患者作为耐药组,等比例选取120例三代头孢敏感大肠埃希菌血流感染患者为敏感组。采用VITEK2检测药敏情况、聚合酶链反应(PCR)扩增耐药基因、脉冲场凝胶电泳(PFGE)进行流行病学调查,统计相关病例资料进行危险因素分析。我们的研究结果发现耐药组120株菌株对多数头孢类抗生素表现耐药,对哌拉西林/他唑巴坦多表现敏感,对碳青霉烯类均敏感;耐药组中超广谱β类酰胺酶(ESBLs)基因占65.00%(78/120);Ⅰ类整合子基因占14.17%(17/120);氨基糖苷类基因和喹诺酮类基因检出率较低,分别占5.83%(7/120)和3.33%(4/120);PFGE结果显示菌株间不存在克隆相关性;危险因素分析结果显示尿路感染(OR=2.222;p=0.029)、感染前手术史(OR=3.063;p=0.014)、头孢类抗生素使用史(OR=2.301;p=0.036)是其独立危险因素。这些结果提示我们血流感染中耐三代头孢大肠埃希菌ESBLs基因检出率高,引起的血流感染多与头孢类抗生素使用史、尿路感染及手术史相关,为此,我们建议临床工作者合理使用抗生素,减少侵入性操作,同时加强医院感染监管工作,从而减少耐药菌的传播与流行。
In order to explore the molecular epidemiological characteristics and risk factors of infection in third-generation-cephalosporin-resistant Escherichia coli (3C-CSF) in bloodstream infection, we finally provide a theoretical basis for prevention and control of clinical medication and infection. During the period from January 2013 to December 2015, the first affiliated hospital of Chongqing Medical University from January 2013 to December 2015 selected 120 cases of third-generation cephalosporin Escherichia coli bloodstream infections as resistance group, 120 cases of equal proportion of selected third generation cephalosporin sensitive Escherichia coli Patients with bacterial bloodstream infection were sensitive. VITEK2 was used to detect the drug susceptibility, polymerase chain reaction (PCR) amplification of drug resistance genes, pulsed-field gel electrophoresis (PFGE) epidemiological investigation, statistical analysis of relevant case data for risk factors. Our results showed that 120 strains of drug-resistant group showed resistance to most cephalosporins, more sensitive to piperacillin / tazobactam and more susceptible to carbapenems, The gene of amidase (ESBLs) accounted for 65.00% (78/120), the class I integron accounted for 14.17% (17/120), the rate of aminoglycoside and quinolone was low, accounting for 5.83% (7 / (OR = 2.222; p = 0.029), preoperative infection history (OR = 3.063; p = 0.029, p = 0.029, p = 0.029); PFGE results showed that there was no clonal correlation between strains; the risk factors analysis showed that urinary tract infection = 0.014). The history of cephalosporin use (OR = 2.301; p = 0.036) was an independent risk factor. These results suggest that we are resistant to third generation Escherichia coli Escherichia coli bloodstream infections in high detection rate of ESBLs, caused by bloodstream infections and more history of cephalosporins antibiotics, urinary tract infection and surgical history, and therefore, we recommend clinical work Reasonable use of antibiotics to reduce invasive operations, while strengthening surveillance of nosocomial infections, thereby reducing the spread and prevalence of resistant bacteria.