摘要
目的分析重症监护室(ICU)患者耐碳青霉烯类肠杆菌科细菌(CRE)的感染特征及危险因素。方法回顾性分析2017年1月-2020年12月上海市胸科医院ICU患者的临床资料,以88例耐碳青霉烯类肠杆菌科细菌(CRE)医院感染的患者为病例组,按1∶1随机选择同期88例对碳青霉烯类敏感肠杆菌科细菌(CSE)感染的患者为对照组,分析感染菌株和感染部位,并通过单因素分析和多因素Logistic回归分析CRE感染的相关因素。结果CRE感染菌株主要以肺炎克雷伯菌60例(68.18%),大肠埃希菌22例(25.00%)为主。CRE感染部位主要以下呼吸道感染共46例(52.27%)、器官腔隙感染13例(14.77%)为主。单因素分析结果显示机械通气、留置导尿管、留置中央静脉导管、使用抗菌药物种类≥3种、碳青霉烯类药物使用史、糖肽类药物使用史、β-内酰胺抑制剂使用史均与CRE感染有关(P<0.05),多因素Logistic回归分析发现,机械通气、留置中央静脉导管、碳青霉烯类药物使用史(P<0.05)是CRE感染的危险因素。结论临床上应对有高危因素的患者定期进行CRE筛查,合理使用广谱抗菌药物,最大限度地减少患者的有创操作,以减少CRE医院感染的发生。
OBJECTIVE To investigate the characteristics and risk factors for carbapenem-resistant Enterobacteriaceae(CRE)infection in intensive care unit(ICU)patients.METHODS The clinical data of the patients who were treated in ICU of Shanghai Chest Hospital from Jan 2017 to Dec 2020 were retrospectively analyzed,88 patients who had CRE nosocomial infection were assigned as the case group,meanwhile,88 patients who had carbapenem-sensitive Enterobacteriaceae(CSE)infection were chosen as the control group.The species of pathogens causing infection and infection sites were analyzed.Univariate analysis and multivariate logistic regression analysis were performed for the related factors for CRE infection.RESULTS Among the patients who had CRE infection,60(68.18%)had Klebsiella pneumoniae infection,and 22(25.00%)had Escherichia coli infection.Among the sites of CRE infection,46(52.27%)had lower respiratory tract infection,and 13(14.77%)had organ lacunar infection.The result of univariate analysis showed that mechanical ventilation,urinary catheter indwelling,central venous catheter indwelling,use of no less than 3 types of antibiotics,history of use of carbapenems,history of use of glycopeptides and history of use of beta-lactam inhibitors were associated with the CRE infection(P<0.05).Multivariate logistic regression analysis indicated that mechanical ventilation,central venous catheter indwelling and history of use of carbapenems were the risk factors for the CRE infection(P<0.05).CONCLUSION It is necessary for the hospital to regularly conduct the screening of CRE for the patients who have the above high risk factors,reasonably use broad-spectrum antibiotics and minimize invasive procedures so as to reduce the incidence of CRE nosocomial infection.
作者
于佳
张静
李莉珊
纪灏
YU Jia;ZHANG Jing;LI Li-shan;JI Hao(Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第21期3215-3219,共5页
Chinese Journal of Nosocomiology
