【作者】 李飞；

【导师】 朱庆雄；

【作者基本信息】 南昌大学 ， 儿科学（专业学位）， 2021， 硕士

【摘要】 目的:分析儿童E.coli血流感染的临床特点,E.coli血流感染产ESBLs的耐药性及危险因素,总结儿童E.coli血流感染的临床特征,有助于临床早诊断、早治疗,指导临床合理、正确选择抗菌药物,为临床早期诊断和治疗产ESBLs的E.coli血流感染提供依据。方法:收集2016年1月至2018年12月江西省儿童医院收治的符合E.coli血流感染标准且出现临床症状的219例患儿临床资料和菌株药敏情况。分析儿童E.coli血流感染的临床特点,根据E.coli菌株是否产ESBLs,将患儿分为产ESBLs组和非产ESBLs组,比较两组的耐药情况,并采用率、比等指标对资料进行统计学描述,利用卡方检验、非参数检验比较组间分布差异。同时进一步对产ESBLs的E.coli血流感染的危险因素进行单因素和多因素Logistic回归分析。结果:1、219例发生E.coli血流感染的患儿中0-1岁年龄段最多,占84.5%,其中以男性患儿多见,占70.3%。好发科室为新生儿科与血液科,临床表现以发热最为常见(101/219,46.1%),并发症以消化系统疾病最为常见(79/219,36.1%)。实验室检查中:110例患儿外周血白细胞>10×10~9/L(110/219,50.2%),73例患儿血红蛋白<100g/L,占33.3%;62例患儿外周血中性粒细胞比值>70%,占28.3%。29例患儿在治疗过程中使用呼吸机,占13.2%。绝大部分患儿经治疗后病情出现好转(162/219,74.0%),只有5例患儿病情恶化,出现死亡。2、药敏结果提示产ESBLs 66株(30.1%),非产ESBLs 153株(69.9%),且产ESBLs的E.coli对常用抗菌药物的耐药率高于非产ESBLs菌株。两组的耐药率(阿米卡星除外)有统计学差异(P<0.05);产ESBLs的E.coli对头孢吡肟、头孢他啶及头孢噻肟的耐药率>85.0%;非产ESBLs的E.coli对常用抗菌药物的耐药率最高的是复方新诺明(52.9%),其次是庆大霉素(30.1%)。3、单因素分析提示,早产、肝肾功能受损、休克、多器官衰竭、有基础疾病、置管、使用呼吸机、入院前抗菌药物应用、体温<36℃、外周血白细胞<4×10~9/L以及住院时间>7d可增加产ESBLs的E.coli血流感染的风险。进一步行多因素Logistic回归分析提示早产、肝肾功能受损、休克、多器官衰竭、有基础疾病、置管、使用呼吸机、体温<36℃是产ESBLs的E.coli血流感染的独立危险因素。结论:1、大肠埃希菌血流感染的患儿0-1岁最为常见,占84.5%。2、血流感染产ESBLs的E.coli菌株对常用抗菌药物的耐药率高于非产ESBLs菌株,产ESBLs的E.coli菌株对头孢菌素类药物的耐药率高达85%以上。3、产ESBLs的E.coli菌株对阿米卡星以及碳青霉烯类抗菌药物最为敏感。4、早产、肝肾功能受损、休克、多器官衰竭、有基础疾病、置管、使用呼吸机、体温<36℃是产ESBLs的E.coli血流感染的独立危险因素。更多还原

【Abstract】 Objective:To analyze and summarize the clinical characteristics,the drug resistance and risk factors of extended-spectrum β-lactamases(ESBLs)producing of Escherichia coli(E.coli)bloodstream infection,in children,helpful for clinical diagnosis and treatment,which,not only for guiding rational application of antibacterial drugs and correct selection of antibiotics,but also providing evidence for early clinical diagnosis and treatment.Methods:The clinical data and bacterial susceptibility of 219 children with E.coli bloodstream infection standards and clinical symptoms admitted to Jiangxi Children’s Hospital,From January 2016 to December 2018,were collected to analyze,then divide the children into ESBLs-producing and non-ESBLs-producing groups according to whether E.coli strains produce ESBLs or not,compare the resistance,adopt indicators such as rate and ratio to described statistically,and the distribution differences between groups were compared using chi-square test and non-parametric test.At the same time,the risk factors of ESBLs producing E.coli bloodstream infection were further analyzed by univariate and multivariate Logistic regression analysis.Results:1、The age of the 219 children with E.coli bloodstream infections was 0-1 years old,accounting for 84.5%,of which male children accounted for 70.3%.The most Department is the Department of Neonatology and Hematology.Fever was the most common clinical manifestation(101 cases,46.1%),and the most common complications were digestive system diseases(79 cases,36.1%).In laboratory examination: 110 cases of children with peripheral blood leukocytes >10×109/L,accounting for 50.2%;73 cases of children with hemoglobin <100g/L,accounting for33.3%;62 cases of children with peripheral blood neutrophil ratio>70 %,accounting for 28.3%.29 cases of children used ventilator during treatment,accounting for13.2%.The condition of most children improved after treatment(162 cases,74.0%),and only 5 cases deteriorated and died.2、 The drug susceptibility results indicated that 66 ESBLs-producing strains(30.1%),153 were not ESBLs-producing strains(69.9%),and the resistance rate of ESBLs-producing E.coli to commonly used antibacterial drugs was higher than that of non-ESBLs-producing strains.The resistance rate of the two groups(except for amikacin)was statistically different(P<0.05);The resistance rate of ESBLsproducing E.coli to cefepime,ceftazidime and cefotaxime was >85.0%;non-ESBLsproducing E.coli The highest resistance rate of E.coli to commonly used antibacterial drugs was compound trimethoprim(52.9%),followed by gentamicin(30.1%).3、Premature delivery,impaired liver and kidney function,shock,multiple organ failure,underlying diseases,catheterization,use of ventilator,use of antibacterial drugs before admission,body temperature <36℃,peripheral blood white blood cells<4×109/L,and Hospitalization time> 7 days,Univariate analysis indicated,could increase the risk of E.coli bloodstream infection that produces ESBLs.Then with further multivariate logistic regression analysis,premature delivery,impaired liver and kidney function,shock,multiple organ failure,underlying diseases,catheterization,use of ventilator,body temperature <36 ℃ were independent risk factors for ESBLs-producing E.coli bloodstream infection.Conclusion:1、 Children,aged 0-1,with Escherichia coli bloodstream infection,were the most common,accounting for 84.5%.2、 The resistance rate of ESBLs-producing E.coli strains to commonly used antibacterial drugs in bloodstream infection was higher than that of non-ESBLsproducing strains,and the resistance rate of ESBLs-producing E.coli strains to cephalosporins is as high as 85%.3、 E.coli strains producing ESBLs were most sensitive to amikacin and carbapenem antibiotics.4、 The independent risk factors,for ESBLs-producing E.coli bloodstream infection,were Premature delivery,impaired liver and kidney function,shock,multiple organ failure,underlying diseases,catheterization,use of ventilator,body temperature <36℃.更多还原