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