| 徐秀杰,万佳红,吴丽娜,宁 平,李康怡.住院精神病患者大肠埃希菌感染分布状况、耐药性及其危险因素分析[J].,2020,(6):1159-1163 |
| 住院精神病患者大肠埃希菌感染分布状况、耐药性及其危险因素分析 |
| The Distribution and Drug Resistance and Risk Factors of Escherichia Coli Infection in Psychiatric Inpatients |
| 投稿时间：2019-11-06 修订日期：2019-11-30 |
| DOI：10.13241/j.cnki.pmb.2020.06.036 |
| 中文关键词: 大肠埃希菌 感染 精神病 抗菌药物 耐药性 危险因素 |
| 英文关键词: Escherichia coli Infection Psychosis Antibacterial drugs Drug resistance Risk factor |
| 基金项目:辽宁省科技厅科技攻关项目（2016041063） |
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| 中文摘要: |
| 摘要 目的：了解住院精神病患者大肠埃希菌的感染分布情况及对常用抗菌药物的耐药状况，并分析感染大肠埃希菌的危险因素。方法：回顾性收集2016年1月-2019年1月间1100例接受住院治疗的临床资料，收集其临床标本并分离大肠埃希菌，采用法国生物梅里埃公司的VITEK-32 系统进行菌种鉴定及药敏试验，采用K-B琼脂扩散法检测细菌的耐药性。单因素和多因素logistic回归分析大肠埃希菌感染的危险因素。结果：1100例精神病患者中共有51例患者检出大肠埃希菌感染，感染率为4.64%（51/1100），共分离出87株大肠埃希菌。各类标本来源分布占比从高到低依次是尿液 42.53％(37/87)、痰及呼吸道分泌物36.63％(31/87)，粪便14.94％(13/87)，伤口引流液4.60％(4/87)，血液2.30％(2/87)；科室分布占比从高到低依次是老年科66.67%（58/87），精神科25.29%（22/87），心理科8.05%（7/87）。大肠埃希菌主要对氨苄西林、四环素、环丙沙星、头孢唑啉耐药，耐药率分别为93.25%、80.03%、77.30%、72.51%，对亚胺培南不耐药，耐药率为0.00%。单因素分析结果显示年龄、长期使用抗精神药物、住院时间、侵入性操作和频繁使用抗菌药物治疗均与住院精神病患者大肠埃希菌感染相关（P<0.05）。多因素logistic回归分析结果显示年龄≥55岁、住院时间≥45 d、侵入性操作、长期使用抗精神病药物和频繁使用抗菌药物治疗是住院精神病患者大肠埃希菌感染的危险因素（P<0.05）。结论：大肠埃希菌耐药性日趋严重，临床抗感染治疗上，应根据药敏试验结果、结合实际情况合理选用抗菌药物，有效减少耐药菌株的扩散，降低大肠埃希菌感染。此外，年龄≥55岁、长期使用抗精神病药物和频繁使用抗菌药物治疗、侵入性操作、住院时间≥45d均是大肠埃希菌感染的危险因素，值得重点关注。 |
| 英文摘要: |
| ABSTRACT Objective: To understand the distribution of Escherichia coli infection and the resistance to common antibiotics in psychiatric inpatients, analysis of risk factors of infection with Escherichia coli. Methods: The clinical data of 1100 inpatients between January 2016 and January 2019 were collected retrospectively, clinical specimens and isolation of Escherichia coli were collected . Using VITEK-32 system in French bioMérieux's company to conduct strain identification and susceptibility testing and the method of KB agar diffusion to detect bacterial resistance.Single factor and multiple factor Logistic regression were used to analysis of risk factors of Escherichia coli infection. Results: There were 51 case Escherichia coli infection was detected in 1100 psychiatric patients, the infection rate was 4.64%（51/1100）and 87 strains of Escherichia coli were isolated. From the highest to the lowest, the distribution of all kinds of specimens was 42.53% (37/87) in urine, 36.63% (31/87) in sputum and respiratory secretion, 14.94% (13/87) in feces, 4.60% (4/87) in wound drainage fluid, 2.30% (2/87) in blood, 66.67% (58/87) in geriatrics, 25.29% (22/87) in psychiatry, 8.05% (7/87) in psychology.The resistance rate of Escherichia coli to ampicillin, tetracycline, ciprofloxacin and cefazolin were 93.25%, 80.03%, 77.30% and 72.51% respectively, and the resistance rate to imipenem was 0.00%. Univariate analysis showed showed that age, long-term use of antipsychotics, length of stay, invasive operation and frequent use of antibiotics were all related to E.coli infection in psychiatric inpatients(P<0.05). Multivariate logistic regression analysis showed that Age greater than or equal to 55 years old, hospital stay time greater than or equal to 45 d, invasive operation, long-term use of antipsychotics and frequent use of antibiotics are the risk factors of E.coli infection in hospitalized psychiatric patients(P<0.05). Conclusion: The drug resistance of Escherichia coli is becoming more and more serious. In the clinical anti infection treatment, we should select antibiotics reasonably according to the results of drug sensitivity test and the actual situation, so as to effectively reduce the spread of drug-resistant strains and reduce the infection of Escherichia coli. In addition, age greater than or equal to 55 years old, long-term use of antipsychotics and frequent use of antibiotics, invasive operation, hospital stay time greater than or equal to 45d are all risk factors of E.coli infection, which is worthy of special attention. |
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