热带病与寄生虫学

热带病与寄生虫学 ›› 2023, Vol. 21 ›› Issue (2): 102-107.doi: 10.3969/j.issn.1672-2302.2023.02.009

• 论著 • 上一篇    下一篇

ICU患者耐碳青霉烯类肠杆菌目细菌感染特征及危险因素分析

陈祥凤(), 张振华, 吴贻乐, 胡小骞, 刘周, 杨旻, 孙昀, 李景荣, 郑凌, 杨锡瑶, 杨利琦()   

  1. 安徽医科大学第二附属医院，安徽合肥230601
  • 收稿日期:2023-01-16 出版日期:2023-04-20 发布日期:2023-05-04
  • 通信作者: 杨利琦，E-mail: yangliqi365@qq.com
  • 作者简介:陈祥凤，女，硕士在读，研究方向：医院感染与临床防控。E-mail: 1643845273@qq.com
  • 基金资助:
    国家自然科学基金项目(82202572);安徽省教育厅高校自然科学基金重点项目(KJ2021A0321)

Clinical pictures and risk factors for carbapenem-resistant Enterobacteriaceae infection in ICU patients

CHEN Xiang-feng(), ZHANG Zhen-hua, WU Yi-le, HU Xiao-qian, LIU Zhou, YANG Min, SUN Yun, LI Jing-rong, ZHENG Ling, YANG Xi-yao, YANG Li-qi()   

  1. The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
  • Received:2023-01-16 Online:2023-04-20 Published:2023-05-04
  • Contact: YANG Li-qi, E-mail: yangliqi365@qq.com

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摘要：

目的 分析重症监护病房（intensive care units，ICU）患者发生耐碳青霉烯类肠杆菌目细菌（carbapenem-resistant Enterobacteriaceae，CRE）医院感染的特征及危险因素。方法 收集安徽医科大学第二附属医院2018—2020年4个ICU内133例CRE医院感染患者的临床资料，以同期ICU内220例碳青霉烯类药物敏感的肠杆菌目细菌（carbapenem-susceptible Enterobacteriaceae，CSE）医院感染患者作为对照组，分析CRE菌种分布和耐药性并对ICU患者感染CRE的危险因素进行单因素分析和多因素logistic回归分析。结果 ICU患者CRE医院感染标本以呼吸道分泌物最为常见（69.9%，93/133），其次是血液（7.5%，10/133）和腹腔分泌物（6.8%，9/133）。其中检出排名前3位的细菌种类依次是肺炎克雷伯菌（63.9%，85/133）、阴沟肠杆菌（15.0%，20/133）和黏质沙雷菌（6.0%，8/133）。ICU患者感染CRE后30 d死亡率为41.6%，CSE组死亡率为27.6%，差异有统计学意义（χ2=6.879，P<0.01）。CRE菌株对碳青霉烯类药物耐药率极高（≥97%），对庆大霉素（80.8%）、复方新诺明（72.2%）、阿米卡星（51.5%）的耐药率较高，而对头孢他啶阿维巴坦（30.3%）、多粘菌素B（2.9%）、替加环素（2.1%）的耐药率较低。多因素logistic回归分析显示，外院转入ICU、糖皮质激素使用史、碳青霉烯类药物和糖肽类药物使用史为ICU患者医院感染CRE的危险因素。结论 ICU内患者发生CRE医院感染的风险不容忽视。临床上对高危患者定期进行CRE筛查，合理使用抗感染药物和糖皮质激素，可以减少ICU患者医院感染CRE的发生。

关键词: 耐碳青霉烯类肠杆菌目细菌, 重症监护病房, 危险因素, 医院获得性感染

Abstract:

Objective To analyze the clinical characteristics and risk factors of nosocomial infection with carbapenem-resistant Enterobacteriaceae (CRE) in patients in intensive care unit (ICU). Methods The clinical data were obtained from 2018 to 2020 from 133 patients with nosocomial CRE infection in the four ICUs in the Second Affiliated Hospital of Anhui Medical University, and another 220 patients with carbapenem-susceptible Enterobacteriaceae (CSE) nosocomial infections were included as controls. Then the distribution and drug resistance to CRE pathogens were analyzed. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for CRE infection. Results Respiratory secretions were most seen in CRE infection in ICU patients (69.9%, 93/133), followed by blood(7.5%, 10/133) and intra-abdominal secretions (6.8%, 9/133). The top three CRE strains were Klebsiella pneumoniae (63.9%, 85/133), Enterobacter cloacae (15.0%, 20/133) and Serratia marcescens (6.0%, 8/133). The 30-day mortality was 41.6% in the ICU patients following CRE infections, and the mortality of CSE group was 27.6%. The difference was statistically significant (χ2=6.879, P<0.01). All strains of CRE exhibited extremely high resistance against carbapenems (≥97%), the drug resistance rates to gentamicin (80.8%), cotrimoxazole (72.2%), amikacin (51.5%) were relatively higher, while to ceftazidime-avibactam (30.3%), polymyxin B (2.9%) and tigecycline (2.1%) remained much lower. Multivariate logistic regression analysis showed that patients transferred to ICU from another hospital, exposure to glucocorticoids, carbapenems and glycopeptides before infection were independent risk factors for nosocomial CRE infections in ICU patients. Conclusion The risks of nosocomial CRE infection in ICU patients cannot be ignored. In clinical practice, regular screening of CRE for high-risk patients and rational use of anti-infective drugs and glucocorticoids can reduce the incidence of nosocomial infection with CRE in ICU patients.

Key words: Carbapenem-resistant Enterobacteriaceae, Intensive Care Unit, Risk factors, Nosocomial infections

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