重症监护病房中耐碳青霉烯类肠杆菌科细菌感染相关危险因素的研究

Study on risk factors of carbapenem resistant Enterobacteriaceae infection in ICU

摘要:

目的 探讨重症监护病房（ICU）中耐碳青霉烯类肠杆菌科细菌（CRE）感染的危险因素，为临床防治提供参考。方法 选取2016年1月—2019年6月中山市人民医院ICU收治的196例医院感染患者的临床资料，根据病原菌检测结果将CRE阳性患者归为CRE组（35例），阴性者为对照组（161例）。分析CRE病原菌分布、耐药特点，采用多因素Logistic回归分析影响ICU患者CRE感染的危险因素。结果 共检出CRE阳性35例，感染率为17.86%（35/196）；共检出68株CRE菌株，以肺炎克雷伯菌检出率最高（52.94%）。CRE菌株对β-内酰胺类、碳青霉烯类等抗菌药物均有不同程度耐药，对多肽类、四环素类抗菌药物较为敏感。CRE组的年龄≥ 50岁、APACHEⅡ评分≥20分、ICU住院时间≥10 d、机械通气时间≥3 d、留置尿管、血液透析、使用碳青霉烯类抗菌药物、使用头孢类抗菌药物、联合用药占比均高于对照组（P <0.05）。多因素Logistic回归分析结果显示，APACHEⅡ评分≥20分［O^R=2.065（95% CI：1.325，12.592）］、使用碳青霉烯类抗菌药物［O^R=2.812（95% CI：1.432，19.624）］、联合用药［O^R=3.785（95% CI：1.523，23.274）］、机械通气时间≥3 d ［O^R=2.134（95% CI：1.115，9.642）］和ICU住院时间≥10 d ［O^R=1.996（95% CI：1.205，7.064）］是ICU患者CRE感染的危险因素（P <0.05）。结论 ICU内CRE感染率高，病情重、碳青霉烯类抗菌药物暴露史、联合使用多种抗菌药物、机械通气时间和ICU住院时间延长是CRE感染的危险因素。

Abstract:

Objective To explore the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) infection in ICU of hospital, and to provide reference for clinical prevention and treatment.Methods From January 2016 to June 2019, 196 patients with nosocomial infection admitted to ICU of Zhongshan People's Hospital were retrospectively selected and divided into CRE group (35cases with CRE positive) and control group (161 cases with CRE negative) according to CRE test results. The distribution, drug resistance, and clinical data of CRE were analyzed. The risk factors of CRE infection in ICU were analyzed by multiple logistic regression.Results 35 cases of CRE were positive, the infection rate was 17.86% (35/196), 68 strains of CRE were detected, and Klebsiella pneumonia was the highest (52.94%). CRE strains are resistant to cephalosporins, penicillins, carbapenems, and other antimicrobials to varying degrees, and sensitive to polymyxin and tegafycline. The results of univariate analysis showed that the age, Apache Ⅱ score at checking in ICU, length of stay in ICU, mechanical ventilation time, proportion of indwelling catheter, proportion of hemodialysis, proportion of carbapenem antimicrobials, proportion of cephalosporin antimicrobials, proportion of combined drugs of CRE group were higher than those of control group (P < 0.05). Multivariate logistic regression analysis showed that Apache Ⅱ score ≥ 20 scores at checking in ICU[O^R=2.065（95% CI:1.325,12.592）],carbapenem antimicrobials[O^R=2.812（95% CI:1.432,19.624）], combination of drugs[O^R=3.785（95% CI:1.523,23.274）], mechanical ventilation time ≥ 3 days[O^R=2.134（95% CI:1.115,9.642）], ICU hospitalization time ≥ 10 days[O^R=1.996（95% CI:1.205,7.064）] were the risk factors of CRE infection in ICU (P < 0.05).Conclusion The rate of CRE infection is high in ICU. Serious illness, exposure history of carbapenem antimicrobials, combined use of multiple antimicrobials, mechanical ventilation time, and prolonged hospital stay in ICU are risk factors of CRE infection.