| Objective:To understand the clinical characteristics and antibiotics resistance of Escherichia coli infected with blood,cerebrospinal fluid and sterile body fluids in hospitalized children,explore the risk factors of ESBLs-producing Escherichia coli,and provide scientific and clinical evidence for the prevention and treatment of ESBLs Escherichia coli infection.Methods: A total of 48 hospital children infected with Escherichia coli in blood,cerebrospinal fluid,and sterile body fluids in Tianjin Children’s Hospital from January 1st,2016 to December 31 st,2018 were analyzed.The clinical data including the children’s gender,age,inpatient department,infection route,presence of underlying disease,length of hospital stay,whether antibiotics were applied before surgery,whether surgery was performed,whether ventilator was used and Escherichia coli antibiotics sensitivity results to analysis the clinical characteristics of Escherichia coli infection.According to whether ESBLs were produced,the clinical cases were divided into ESBLs-producing group(18 cases)and non-ESBLs-producing group(30 cases).The risk factors of ESBLs-producing Escherichia coli infection were analyzed by case-control study.Results: In the 48 cases,36 were male and 12 were female.The male to female ratio of cases was 3: 1,and their age ranged from 6 hours to 13 years old(median 8 years).Among them,17 cases(35.4%)were younger than 28 days.There were 36 cases(75%)in department of internal medicine and 12 cases(25%)in department of surgery.The main clinical diagnosis of 48 children were as following: 11 cases of suppurative meningitis(7 cases combined with bloodstream infection,2 cases with bloodstream infection and urinary tract infection);There were 13 cases of abdominal intestinal infection(9 cases with bloodstream infection),16 cases with urinary tract infection and bloodstream infection,1 case with umbilical infection and bloodstream infection,and 7 with simple bloodstream infection.Among them,suppurative meningitis was the most common in neonates(9 cases)than other children,accounting for 64.7% of Escherichia coli infection.Infant urinary tract infection was the most common cause of bloodstream infections,accounting for 77.8% of E.coli infections in this study.In school-aged children,appendicitis with bloodstream infection was more common(60%).21 patients(43.8%)had underlying diseases including premature delivery(9 cases),neonatal respiratory distress syndrome(2 cases),umbilical fistula(3 cases),intestinal development abnormalities(3 cases)and leukemia(6 cases).The definite infection route accounted for 66.7% of the total,including urinary tract(18 cases),intestinal tract(13 cases),and umbilicus(1 case).Ten children(20.8%)underwent surgery.Ventilator-assisted ventilation was used in 3 cases(6.3%).The departments with the highest detection rates of ESBLs-producing Escherichia coli are hematology,neonatal medicine and neonatal surgery.Univariate analysis showed the presence of underlying disease,nosocomial infection,hospitalization within 3 months,and antibiotic treatment before bacterial culture were the influencing factors for ESBL-producing Escherichia coli infection(P <0.05).Multivariate logistic regression analysis showed that antibiotic treatment before bacterial culture(OR = 6.168,P = 0.03)was an independent risk factor for ESBLproducing Escherichia coli infection.There was no significant statistical difference in the antibiotics resistance of amikacin,cefoperazone/sulbactam,ciprofloxacin,nitrofurantoin,gentamicin,imipenem,levofloxacin,meropenem,piperacillin/tazobactam between ESBLs-producing and non-ESBL-producing Escherichia coli,and the differences in antibiotics resistance of the other antibiotics were statistically significant.In the ESBLs-producing Escherichia coli,5.56% were resistant to amikacin,the cefoperazone/sulbactam resistant rate was 5.56%,and the meropenem resistance rate was 5.56%,which had the lower resistance rate.There were not resistant to tigecycline(TGC)both in ESBLs-producing and non-ESBLsproducing Escherichia coli.Conclusions:1.For the infection of Escherichia coli with ESBLs produced in blood,cerebrospinal fluid and sterile body fluids,the departments with the highest detection rate in our hospital were hematology,neonatology,and neonatal surgery.Neonates had a high percentage of purulent meningitis,and infants had a higher percentage of urinary tract infections and bloodstream infections.2.There was no significant difference in gender,age,route of infection,surgery,ventilator use and prognosis between the ESBLs group and the non-ESBLs group,while the clinical characteristics including underlying diseases,nosocomial infections,hospitalization within 3 months and antibiotic treatment before bacterial culture were the risk factors for ESBLproducing Escherichia coli infection.Pre-culture antibiotic use was an independent risk factor for ESBL-producing Escherichia coli infection.3.The ESBLs Escherichia coli isolates in our hospital were relatively sensitive to amikacin,cefoperazone,sulbactam,meropenem and tigecycline,which should be preferred in clinical treatment.In clinic,we should avoid the antibiotics with the higher resistant rate,use the antibacterial drugs reasonably according to clinical symptoms to delay the production of the antibacterial drugs resistant bacteria and consider the restrictions on pediatric medication during medication.4.Reasonable use of medical resources,analysis of clinical characteristics during treatment,rational application of antibiotics,prevention and control of ESBLs-producing Escherichia coli infection and transmission,which could reduce burden and suffer for children. |
PDF Full Text Request