耐碳青霉烯类肠杆菌医院感染风险分析  

Risk factors for nosocomial infections due to carbapenem-resistant Enterobacteriaceae

作　　者：李鹏[1] 李轶[2] 张付华[1] 王婷婷[1] 王山梅[2] 孙明洁[1] 

机构地区：[1]河南省人民医院医院感染管理科,河南郑州450003 [2]河南省人民医院检验科微生物室,河南郑州450003

出　　处：《中华医院感染学杂志》2015年第11期2417-2419,共3页Chinese Journal of Nosocomiology

基　　金：河南省科技厅基础与前沿技术研究基金资助项目(132300410038)

摘　　要：目的识别耐碳青霉烯类肠杆菌(CRE)医院感染的风险关键控制点,以提升CRE感染预防控制水平。方法基于医院信息系统,回顾性调查医院2013年1月-2015年2月CRE医院感染患者的临床资料,通过构建非条件logistic回归模型分析,预测CRE医院感染的风险,数据分析采用SAS9.2软件。结果 121例CRE医院感染患者主要分布在外科、ICU和内科,分别占35.5%、28.9%和24.8%;感染部位主要为下呼吸道、血液、泌尿道和手术部位,分别占46.0%、16.0%、14.0%和10.0%;主要耐药菌是肺炎克雷伯菌占73.4%、大肠埃希菌占18.8%;多因素分析显示,入住ICU、联用抗菌药物、感染前使用碳青霉烯类抗菌药物是CRE医院感染的独立危险因素。结论对重点科室住院患者开展早期CRE筛查,合理使用碳青霉烯类抗菌药物并减少联用,可降低CRE医院感染的风险。OBJECTIVE To identify the risk factors for nosocomial infections caused by the carbapenem‐resistant Enterobacteriaceae （CRE） so as to improve the control and prevention of the CRE infections .METHODS Based on the information system ,the clinical data of the patients with CRE infections who were treated in the hospital from Jan 2013 to Dec 2015 were retrospectively investigated ,then the non‐conditional logistic regression model was established to predict the risk of the CRE infections ,and the data were analyzed by using SAS9 .2 software . RESULTS Of the 121 patients with CRE infections ,35 .5% distributed in the surgery department ,28 .9% in the ICU ,24 .8% in the internal medicine department ;46 .0% had the lower respiratory tract infections ,16 .0% had the blood infections ,14 .0% had the urinary tract infections ,and 10 .0% had the surgical site infection .The Klebsiella pneumoniae and Escherichia coli were the major species of drug‐resistant bacteria ,accounting for 73 .4% and 18 .8% ,respectively .The multivariate analysis indicated that the ICU stay ,combined use of antibiotics ,and use of carbapenems before the infection were the independent risk factors for the CRE infections . CONCLUSIONS It is necessary to conduct the early screening of CRE for the hospitalized patients in the key departments , reasonably use carbapenems ,and cut down the combined use so as to reduce the risk of the CRE infections .

关 键 词：医院感染 耐碳青霉烯类肠杆菌 风险分析 

分 类 号：R378.2[医药卫生—病原生物学]