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目的探讨哌拉西林-他唑巴坦替换第三代头孢菌素对肠道产超广谱β-内酰胺酶(ESBLs)大肠埃希菌定植的影响。方法研究为期9个月,分替换前期(Ⅰ期,3个月)和替换期(Ⅱ期,6个月);Ⅱ期用哌拉西林-他唑巴坦替换第三代头孢菌素;收集Ⅰ期和Ⅱb期(Ⅱ期后3个月)入选患者临床资料,入院24h 采集第一份直肠拭子(基线筛查),并每7天或在出院前48h 采集直肠拭子分离大肠埃希菌,双纸片法检测 ESBLs;对至少进行过2次直肠拭子检查的患者(ES1人群)和 ES1人群中在筛查或住院期间至少有1次未检出 ESBLs 的患者(ES2人群)分别分析产 ESBLs 大肠埃希菌获得率;采用非配对 t 检验、Pearson 卡方检验和 Fisher 精确检验进行比较。结果Ⅱb期抗生素总用量(除哌拉西林-他唑巴坦)较Ⅰ期减少38.40%,第三代头孢菌素用量较Ⅰ期减少70.11%;哌拉西林-他唑巴坦用量增加895.35%;Ⅱb期 ES1和 ES2人群产 ESBLs 大肠埃希菌获得率明显低于Ⅰ期(11.4%比24.0%;11.8%比27.9%)。结论哌拉西林-他唑巴坦替换第三代头孢菌素可降低肠道产 ESBLs 大肠埃希菌定植。
Objective To investigate the effects of piperacillin-tazobactam replacement of third-generation cephalosporins on the colonization of Escherichia coli producing extended-spectrum β-lactamases (ESBLs). Methods The study period was 9 months. The subjects were divided into pre-replacement stage (stage I, 3 months) and replacement stage (stage II, 6 months); stage II was replaced with piperacillin-tazobactam for the third generation cephalosporin; Patients in stage I and IIb (3 months after stage II) were enrolled in the clinical data, the first rectal swab was collected 24h after admission (baseline screening), and rectal swabs were collected every 7 days or 48 hours before discharge. ESBLs were detected by the bacterial and biopsy methods; in at least 1 ESBLs-free (ES2 population) patients who had rectal swab exams in at least 2 rejections (ES1 population) and ES1 populations during screening or hospitalization The yield of ESBLs-producing Escherichia coli was analyzed; unpaired t-test, Pearson chi-square test and Fisher’s exact test were used for comparison. Results The total amount of antibiotics in stage Ⅱb (except piperacillin - tazobactam) was decreased by 38.40% compared with that of stage Ⅰ, the dosage of the third generation cephalosporins was 70.11% less than that of stage Ⅰ, the dosage of piperacillin - tazobactam was increased by 895.35% The production rate of ESBLs-producing Escherichia coli in stage Ⅱb ES1 and ES2 patients was significantly lower than that in stage Ⅰ (11.4% vs 24.0%; 11.8% vs. 27.9%). Conclusion Piperacillin-tazobactam replacement of the third generation cephalosporins can reduce the ESBLs-producing Escherichia coli colonization.