| 摘要: |
| ［摘要］ 目的 分析院内多重耐药大肠埃希菌（MDR-ECO）肺炎的耐药现状及影像学特征，并探讨发生MDR-ECO感染的危险因素。方法 选择2018-07-01～2020-06-30潍坊市人民医院经呼吸道或者血标本分离检测确认的大肠埃希菌所致院内获得性肺炎(HAP)患者178例的病历资料，根据致病菌是否为多重耐药菌将其分为MDR-ECO组（153例）和非MDR-ECO组（25例）。分析其耐药情况及影像学特征，采用多因素logistic回归分析模型探讨发生MDR-ECO感染的危险因素。结果 在178例标本中共检出MDR-ECO标本153株（85.96%）。药敏试验结果显示，MDR-ECO对头孢唑林、头孢呋辛及青霉素类耐药率达95%以上，对庆大霉素、氨曲南及环丙沙星耐药率均高达50%以上，对三代头孢菌素头孢他定、头孢噻肟的耐药率分别为46.41%和83.01%，对四代头孢菌素头孢吡肟的耐药率为30.07%。MDR-ECO对厄他培南耐药率最低，为0.65%。与非MDR-ECO组比较，MDR-ECO组病变多累及双侧肺部，有斑片渗出、实变、间质改变、空洞的比例以及无结节的比例较高，差异均有统计学意义（P<0.05）。多因素logistic回归分析结果显示，合并基础疾病、入住ICU是发生MDR-ECO感染的危险因素（P<0.05）。结论 MDR-ECO所致HAP的耐药现状严峻，临床医师应根据危险因素及影像学特点，合理使用抗生素，减少耐药菌产生。 |
| 关键词: 多重耐药大肠埃希菌 院内获得性肺炎 危险因素 耐药 影像学特征 |
| DOI：10.3969/j.issn.1674-3806.2021.02.10 |
| 分类号:R 563.1 |
| 基金项目:潍坊市卫生局科研项目［（2014）年第0000441号］ |
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| Current status and imaging characteristics of multidrug-resistant Escherichia coli pneumonia in hospital |
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LIU Ting, XU Jian-xiu, YANG Chun-li, et al.
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Department of Pulmonary and Critical Care Medicine, Weifang People′s Hospital, Shandong 261041, China
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| Abstract: |
| ［Abstract］ Objective To analyze the current status and imaging characteristics of multidrug-resistant Escherichia coli(MDR-ECO) pneumonia in hospital, and to explore the risk factors of MDR-ECO infection. Methods The medical records of 178 patients with hospital acquired pneumonia(HAP) caused by Escherichia coli confirmed by the respiratory tract or blood sample isolation test in Weifang People′s Hospital from July 1, 2018 to June 30, 2020 were selected. The pathogenic bacteria were divided into MDR-ECO group(153 cases) and non-MDR-ECO group(25 cases) according to whether they were multidrug-resistant bacteria. Their drug resistance and imaging characteristics were analyzed. The risk factors of MDR-ECO infection were investigated by multivariate logistic regression analysis model. Results One hundred and fifty-three strains of MDR-ECO specimens(85.96%) were detected in the 178 specimens. The results of drug susceptibility test showed that the drug resistance rates of MDR-ECO to cefazolin, cefuroxime and penicillins were more than 95%, and the drug resistance rates to gentamicin, aztreonam and ciprofloxacin were more than 50%. The drug resistance rates to ceftazidime and cefotaxime(the third-generation cephalosporins) were 46.41% and 83.01%, respectively, and the drug resistance rate to cefepime(the fourth-generation cephalosporin) was 30.07%. MDR-ECO had the lowest drug resistance rate to ertapenem(0.65%). Compared with the non-MDR-ECO group, the MDR-ECO group has more lesions involving both sides of the lungs, and higher proportions of patchy exudation, consolidation, interstitial changes, cavities and non-nodular lesions, and the differences were statistically significant between the two groups(P<0.05). Multivariate logistic regression analysis showed that co-existing underlying diseases and Intensive Care Unit(ICU) admission were the risk factors of MDR-ECO infection(P<0.05). Conclusion The current status of drug resistance of HAP caused by MDR-ECO is severe. Clinicians should use antibiotics rationally according to the risk factors and imaging characteristics to reduce the production of drug-resistant bacteria. |
| Key words: Multidrug-resistant Escherichia coli(MDR-ECO) Hospital acquired pneumonia(HAP) Risk factors Drug resistance Imaging features |
