摘要
目的探讨耐碳青霉烯类肠杆菌(CRE)血流感染患者临床特征和治疗策略。方法回顾性分析四川省人民医院2018年9月—2021年12月CRE血流感染患者的人口统计学信息、微生物学和临床特征。结果共有53例CRE血流感染患者符合纳入标准,治疗失败率47.2%。治疗失败患者降钙素原(PCT)、C-反应蛋白(CRP)、乳酸脱氢酶、凝血酶原时间水平较高,球蛋白水平较低(P<0.05)。单药治疗(n=15)和联合用药治疗(n=38)的差异无统计学意义(P>0.05)。含有替加环素的治疗方案并不优于不含替加环素的其他策略(P>0.05)。单因素分析结果显示,CRE血流感染预后与气管插管、深静脉置管、菌株感染类型、合并肝胆系统疾病、感染发生于入住重症监护室(ICU)后有关(P<0.05)。合并肝胆系统疾病、感染发生于入住ICU后是CRE血流感染预后的独立危险因素(P<0.05)。结论CRE血流感染患者病死率高,PCT、CRP高的患者提示预后差,替加环素单药使用或联用可能不是CRE相关BSI的最佳治疗选择。
Objective To explore the clinical characteristics and treatment strategies of patients with Carbapenem-resistant Enterobacteriaceae(CRE)bloodstream infection.Methods A retrospective analysis was conducted on demographic information,microbiological data,and clinical characteristics of patients with CRE bloodstream infections in Sichuan Provincial People's Hospital from September 2018 to December 2021.Results A total of 53 cases of CRE bloodstream infections were identified,with a treatment failure rate of 47.2%.Patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)had a worse prognosis(P<0.05).Patients with treatment failure showed higher levels of procalcitonin,C-reactive protein,lactate dehydrogenase,and prolonged prothrombin time,along with lower levels of globulin(P<0.05).Among the 53 patients included in the outcome analysis following drugs,there was no statistically significant difference between monotherapy(n=15)and combination therapy(n=38)(P>0.05).Treatment regimens containing tigecycline were not superior to other strategies without tigecycline(P>0.05).Univariate analysis results indicated that the prognosis of CRE bloodstream infection was associated with endotracheal intubation,central venous catheterization,bacterial species which lead infection,comorbidities of the hepatobiliary system,and infection occurring after ICU admission(P<0.05).Health issues involving the hepatobiliary system and ICU-onset admission were independent risk factors for the prognosis of CRE bloodstream infection(P<0.05).Conclusion Patients with CRE bloodstream infections have a high mortality rate,and those with elevated procalcitonin and C-reactive protein levels indicate a poor prognosis.The use of tigecycline in combination or alone may not be the optimal treatment choice for CRE-related BSI.
作者
刘颖
孙普娇
徐开菊
杨仁国
杨兴祥
LIU Ying;SUN Pujiao;XU Kaiju;YANG Renguo;YANG Xingxiang(Department of Infectious Diseases,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,China)
出处
《医药导报》
CAS
北大核心
2024年第10期1578-1582,共5页
Herald of Medicine
基金
四川省人民医院青年人才基金计划项目(2022QN27)。
关键词
耐碳青霉烯类肠杆菌
血流感染
临床特征
Carbapenem-resistant Enterobacteriaceae
Bloodstream infection
Clinical characteristics
