【摘要】：目的了解社區(qū)獲得性膽道感染細(xì)菌多重耐藥的現(xiàn)狀及有關(guān)危險(xiǎn)因素,便于指導(dǎo)臨床用藥。方法回顧性收集從2014年4月至2016年9月重慶市人民醫(yī)院三院院區(qū)肝膽外科對(duì)社區(qū)獲得性膽道感染患者進(jìn)行膽汁細(xì)菌培養(yǎng)所得146株細(xì)菌的藥敏試驗(yàn)資料及患者的有關(guān)臨床資料(年齡、體質(zhì)指數(shù)、是否患糖尿病、是否患高血壓、是否患高脂血癥、是否患惡性腫瘤、是否曾經(jīng)住院、是否膽道感染反復(fù)發(fā)作3次以上、膽道感染部位、是否膽囊腫大/膽總管擴(kuò)張、是否低蛋白血癥、感染細(xì)菌種類、入院前90 d內(nèi)是否使用抗生素、本次膽道感染發(fā)作后是否使用抗生素、本次膽道感染發(fā)作后是否長時(shí)間使用抗生素7 d以上),并對(duì)可能的有關(guān)因素進(jìn)行單因素分析和多因數(shù)logistic回歸分析。結(jié)果本研究共發(fā)現(xiàn)多重耐藥菌株43株,其構(gòu)成如下:大腸埃希菌72.1%、肺炎克雷伯菌4.7%、陰溝腸桿菌4.7%、其他18.6%。多重耐藥總發(fā)生率為29.4%(43/146),其中大腸埃希菌60.8%、肺炎克雷伯菌7.1%、陰溝腸桿菌11.8%、其他16.0%。多重耐藥的大腸埃希菌對(duì)各種抗生素的敏感率從高到低依次如下:阿米卡星100.0%、亞胺培南90.3%、厄他培南90.3%、頭孢替坦83.9%、哌拉西林/他唑巴坦77.4%。單因素分析發(fā)現(xiàn)年齡(≥60歲)、膽道感染部位(膽管)、膽囊腫大/膽總管擴(kuò)張、低蛋白血癥、膽道感染細(xì)菌種類(大腸埃希菌)、本次膽道感染發(fā)作后長時(shí)間(≥7 d)使用抗生素與膽道多重耐藥細(xì)菌感染有關(guān)(P0.05)。多因數(shù)分析發(fā)現(xiàn)年齡(≥60歲)、膽道感染細(xì)菌種類(大腸埃希菌)、本次發(fā)作后長時(shí)間(≥7 d)使用抗生素與膽道多重耐藥細(xì)菌感染有關(guān)(P0.05)。結(jié)論社區(qū)獲得性膽道感染多重耐藥情況較嚴(yán)重,主要多重耐藥菌為大腸埃希菌,對(duì)多重耐藥大腸埃希菌敏感性較高的抗生素依次為阿米卡星、亞胺培南、厄他培南、頭孢替坦和哌拉西林/他唑巴坦。年齡(≥60歲)、感染細(xì)菌種類和本次發(fā)作后長時(shí)間(≥7 d)使用抗生素是膽道細(xì)菌多重耐藥的危險(xiǎn)因素。
[Abstract]:Objective to investigate the present situation and risk factors of multidrug resistance in community acquired biliary tract infection. Methods from April 2014 to September 2016, 146 strains of bacteria were collected from hepatobiliary surgery of the third Hospital of Chongqing people's Hospital. Relevant clinical data (age, Body mass index (BMI), diabetes, hypertension, hyperlipidemia, malignant neoplasms, hospitalization, repeated episodes of biliary tract infection, location of biliary tract infection, cholecystitis / choledochus dilatation, Whether hypoproteinemia, the type of infection bacteria, whether to use antibiotics within 90 days before admission, whether to use antibiotics after the attack of biliary tract infection, Whether to use antibiotics for more than 7 days after the attack of biliary tract infection, and to make univariate analysis and multifactor logistic regression analysis to the possible related factors. Results A total of 43 multidrug resistant strains were found in this study. Their composition was as follows: Escherichia coli 72.1, Klebsiella pneumoniae 4.7, Enterobacter cloacae 4.7and others 18.6. The total incidence of multidrug resistance was 29.4% (43 / 146), among which Escherichia coli was 60.8, Klebsiella pneumoniae 7.1, Enterobacter cloacae 11.8and others 16.0. The susceptibility rates of multidrug resistant Escherichia coli to various antibiotics were as follows: amicacin 100.0, imipenem 90.3, ertapenem 90.3, ceftitan 83.9, piperacillin / tazobactam 77.4. Univariate analysis showed age (鈮，

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