Bloodstream Infections In Community And Hospital E. Coli Resistance Analysis And Clinical Features

Objective:Highly pathogenic and high mortality rate of Bloodstream infections bring challenges to clinical therapy. With literature reported that patients with hospital-acquired bloodstream infections total mortality was 27.85%, including hospital-acquired bloodstream infections caused by e. coli mortality 22.29%.At the same time, the hospital isolates resistance is generally higher than the community bloodstream infections.In this experiment,1) Monitoring drug resistance of e. coli in bloodstream infections from our hospital,and analying community and hospital drug-resistant of e. coli in bloodstream infections.2) Comparative analysis clinical epidemiological investigation data of ESBL-producing E.coli of bloodstream infections in community and hospital.3) Analyze the epidemic characteristics of genotype of ESBL-producing E.col in bloodstream infections.Methods:Collection 181 strains of e.Coli in community and hospital bloodstream infections of our hospital from 1-December,2014,there were 88 strains of community infection and 93 strains of hospital infection.By the K-B paper disk diffusion method、VITEK-2 Compact GN and AST-GN14 measure the antibiotic sensitivity and resistance of e. Coli, and analysis the characteristics of drug resistance; Analysis of clinical epidemiological investigation about bloodstream infections of ESBL-producing E.coli in 115 strains and the distribution between departments; Polymerase chain reaction (PCR) was used and PCR amplification was carried out on the beta lactamase gene, and detect the genotype of ESBL-producing E.coli in 115 strains of bloodstream infections.Result: ①Positive rate (53.4%) of community bloodstream infections producing ESBLs e. coli was significantly lower than the positive rate (73.1%) of hospital bloodstream infections producing ESBLs e. coli(P=0.006). Drug resistance rate of cefoperazone/sulbactam、Piperacillin/tazobactam、Ertapenem、Imipenem、Amikacin is less than 10%, hospital infection strains resistant rate is generally higher than community infection strains.In 181 strains of e. coli bloodstream infections, Escherichia coli that resistance to carbon penicillium alkene is about 3.9%(7 strains).② Positive rates of bloodstream infections producing ESBLs e. coli of ICU department patients in community and hospital were 71.4% and 77.7% respectively. Positive rates of bloodstream infections producing ESBLs e. coli of urology patients in community and hospital were 69.2% and 82.4% respectively. Positive rates of bloodstream infections producing ESBLs e. coli of general surgical inpatients in community and hospital were 54.1% and 78.6% respectively. The positive rates in these departments were higher than other departments,the positive rates of bloodstream infections producing ESBLs e. coli in hospital were higher than the positive rates of community.③In the clinical data of observation indexes,the indexes of whether to stay in medical institutions in nearly three months、the use of antibiotic catheter indwelling and mechanical ventilation had significant differences and had statistical significance.④In 115 producing ESBLs strains of e. coli, CTX-type is about 95% and CTX-M-lis about 35%, CTX-M-9 is about 63%; TEM-type is about 53%, SHV-type is about 15%.58 strains(50.4%)carry two genes at the same time and 13 strains (11.3%)carry three genes at the same time.Conclusion:The drug resistance rate of Escherichia coli in bloodstream infections in the community is generally lower than hospital infection in our hospital. The positive rates of patients’ bloodstream infections producing ESBLs e. coli in departments of ICUs Urology Surgery、General surgery dept were higher than other departments,or that might have something to do with whether to stay in medical institutions、the use of antibiotic invasive operation. The genotypes of e. coli producing ESBLs were mainly CTX type, followed by TEM and SHV. Paying attention to hospital infection control、invasive operation and raising awareness of the sterile of medical personnel、 rational use of antibiotics, strengthening infection monitoring of ICU and urology ward were effective measures to control the bacterial drug resistance.