| 曹依秀,鲍强,王光璞,等.老年 2型糖尿病合并大肠埃希氏菌血流感染菌株耐药趋势和预后分析[J].安徽医药,2021,25(4):764-768. |
| 老年 2型糖尿病合并大肠埃希氏菌血流感染菌株耐药趋势和预后分析 |
| Drug resistance trend and prognosis of elderly patients with type 2 diabetes complicated by Escherichia coli bloodstream infection |
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| DOI：10.3969/j.issn.1009-6469.2021.04.032 |
| 中文关键词: 糖尿病， 2型 埃希氏菌属 血流感染 抗药性，细菌 老年人 |
| 英文关键词: Diabetes mellitus, type 2 Escherichia Bloodstream infection Drug resistance, bacterial Aged |
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| 中文摘要: |
| 目的探讨老年 2型糖尿病(type 2 diabetes mellitus，T2DM)合并大肠埃希氏菌血流感染病人的临床特征、菌株耐药性变化及预后的影响因素。方法收集 2013年 1月至 2018年 12月于徐州医科大学附属医院确诊的 117例老年 T2DM合并大肠埃希氏菌血流感染病人的临床资料及菌株的药敏结果，使用趋势 χ2检验分析菌株对抗生素的耐药性趋势变化。并将所有研究对象按照临床治疗结局分为生存组(85例)和死亡组(32例)采用单因素分析影响预后的相关因素，采用二元 logistic回归分析分析预后的影响因素。结果老年 T2DM病人大肠埃希氏菌血，流感染主要途径是泌尿道(30.8%，36/117)、呼吸道(24.8%， 29/117)、消化道(17.9%，21/117)，主要合并高血压(59例)、脑梗塞(37例)、实体肿瘤(25例)等基础疾病。纳入菌株四环素、头孢唑啉、头孢噻肟、哌拉西林、氨苄西林耐药情况呈下降趋势(P<0.05)；其中头孢唑林的耐药率在 2013—2018年分别为 86.7%、86.5%、52.0%，趋势性 χ2检验结果显示有统计学意义(χ2=13.182，P<0.001)；头孢噻肟的耐药率在 2013—2018年分别为 90.0%、 8.1%、40.0%，趋势性 χ2检验结果显示有显著统计学意义(χ2=13.698，P<0.001)；氨苄西林耐药率在 2013—2018年分别为96.7%、100%、68.0%，趋势性 χ2检验结果显示有显著统计学意义(χ2=15.248，P<0.001)。头孢呋辛、头孢曲松、替卡西林、莫西沙星、妥布霉素耐药情况呈上升趋势(P<0.05)；其中头孢呋辛耐药率在 2013—2018年分别为 6.7%、8.1%、34.0%，趋势性 χ2检验结果显示有显著统计学意义(χ2=10.712，P=0.001)；头孢曲松耐药率在 2013—2018年分别为 6.7%、78.4%、44.0%，趋势性 χ2检验结果显示有显著统计学意义(χ2=6.253，P=0.012)；莫西沙星耐药率在 2013—2018年分别为 0.0%、0.0%、34.0%，趋势性 χ2检验结果显示有显著统计学意义(χ2=20.708，P<0.001)。多因素回归分析结果显示，年龄 ≥80岁(OR=5.511，P=0.009)、 T2DM病程≥10年(OR=3.120，P=0.022)、 HbA1c≥7%(OR=4.380，P=0.037)、曾入住 ICU(OR=5.643，P=0.002)是老年 T2DM合并大肠埃希氏菌血流感染病人死亡的独立危险因素。结论对高龄、血糖控制不佳、糖尿病病程长、曾入住 ICU的老年 T2DM大肠埃希氏菌血流感染者应及时合理使用抗生素警惕不良预后的发生。 |
| 英文摘要: |
| Objective To investigate the clinical characteristics, drug resistance changes and prognostic factors of elderly patientswith type 2 diabetes mellitus (T2DM) combined with Escherichia coli bloodstream infection.Methods The clinical data and susceptibility test results of strains from 117 elderly patients with T2DM and Escherichia coli bloodstream infection diagnosed in The AffiliatedHospital of Xuzhou Medical University from January 2013 to December 2018 were collected. The trend χ2 test was used to analyze the trend of antibiotic resistance of strains. All subjects were assigned into survival group (n=85) and death group (n=32) according to theclinical treatment outcomes. Univariate factors were used to analyze the prognostic relevant factors and binary logistic regression analysis was used to analyze the prognostic influencing factors.Results The main sources of Escherichia coli bloodstream infection in elderly T2DM patients were urinary tract (30.8%, 36/117), respiratory tract (24.9%, 29/117), and digestive tract (17.9%, 21/117), whichwere mainly associated with hypertension (59 cases), cerebral infarction (37 cases), solid tumors (25 cases) and other basic diseases.The resistance to tetracycline, cefazolin, cefotaxime, piperacillin, and ampicillin showed a decreasing trend (P<0.05). The resistance rates of cefazolin were 86.7%, 86.5%, 52.0% from 2013 to 2018. The results of trend χ2test showed statistical significance (χ2=13.182, P<0.001). The resistance rates of cefazolin were 90.0%, 8.1%, 40.0% from 2013 to 2018. The results of trend χ2test showed statistical significance (χ2=13.698,P<0.001). The rates of ampicillin resistance were 96.7%, 100% and 68.0% from 2013 to 2018. The results of trend χ2 test showed statistical significance (χ2=15.248,P<0.001). The resistance to cefuroxime, ceftriaxone, ticasillin, moxifloxacin and tobramycin tended to increase (P<0.05). The drug resistance rates of cefuroxime were 6.7%, 8.1% and 34.0% from 2013 to 2018. The trend χ2 test showed statistical significance (χ2=10.712, P=0.001). The drug resistance rates of ceftriaxone were 6.7%, 78.4% and 44.0% from 2013 to 2018. The trend χ2 test showed statistical significance (χ2=6.253, P=0.012). The drug resistance rates of moxifloxacin were 0.0%, 0.0% and 34.0% from 2013 to 2018. The trend χ2 test showed statistical significance (χ2=20.708, P<0.001). The multi-factor regression analysis showed that age equal to or older than 80 years old (OR=5.511, P=0.009), course of T2DM equal to or longer than 10 years (OR=3.120, P=0.022), HbA1c greater than or equal to 7% (OR=4.380, P=0.037), and previous ICU admission (OR= 5.643, P=0.002) were independent risk factors for death in elderly T2DM patients with Escherichia coli bloodstream infection.Conclu? sions Elderly patients with T2DM complicated with Escherichia coli bloodstream infection who are elderly, who have poor blood glucose control, who have a long course of diabetes, and who used to be admitted to the ICU should use antibiotics in a timely and rationalmanner to guard against the occurrence of poor prognosis. |
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