碳青霉烯类抗生素耐药的肠杆科细菌感染和死亡的危险因素分析  

Risk factors for acquisition and mortality of carbapenem-resistant Enterobacteriaceae infection

作　　者：陈亮[1] 刘颖[2] 李真[1] 白鹭[1] 刘佳[1] 

机构地区：[1]北京积水潭医院感染疾病科,100035 [2]北京积水潭医院检验科,100035

出　　处：《临床内科杂志》2018年第1期40-42,共3页Journal of Clinical Internal Medicine

摘　　要：目的探讨碳青霉烯类抗生素耐药的肠杆科细菌（CRE）感染的发生和导致患者死亡的危险因素。方法收集我院CRE感染患者84例，同时随机抽取同期住院的碳青霉烯类抗生素敏感的肠杆科细菌（CSE）感染患者84例及非肠杆菌感染患者84例。采用病例一病例一对照研究的方法探讨CRE感染发生和患者30天死亡的危险因素。结果CRE和CSE患者最常见的致病菌均为肺炎克雷伯杆菌和大肠杆菌。Logistic回归分析结果显示，脑血管病（OR=1．960，95％C10．028～2．708，P=0．017）和碳青霉烯类抗生素使用（OR：2．026，95％C10．031～2．570，P=0．007）是CRE感染的独立危险因素；外科手术史（OR=1．753，95％C10．037～2．809，P=0．026）和静脉置管（OR=1．213，95％a0．092—2．959，P=0．042）是CSE感染的独立危险因素。年龄（OR=1．187，95％CI1．029～1．414，P=0021）、肺部感染（OR=7．081，95％CI2．053～688．270，P=0．029）、血降钙素原（OR=2．098，95％CI1．313～58．799，P=0．037）是CRE感染后30天死亡的独立危险因素。结论临床医生应对导致CRE感染和死亡的危险因素加以重视。Objective To explore the risk factors for acquisition and mortality of carbapenem- resistant Enterobacteriaceae （ CRE ） infection. Methods A total of 84 patients with CRE infections, 84 patients with carbapenem-susceptible Enterobacteriaceae （CSE） infection, and 84 patients with pathogens of non-Enterobacteriaceae infection were enrolled in this study. A case-case-control design was used to explore risk factors for the acquisition and 30-day mortality of CRE infections. Results The most common pathogens were klebsiella pneumoniae and escherichia. Logistic regression analysis demonstrated cerebrovascular disease（ OR = 1. 960,95% C10. 028-2. 708 ,P = 0.017 ） and previous use of carbapenems （OR = 2. 026,95% CI O. 031-2. 570, P = 0. 007 ） were independent risk factors of CRE acquisition. Surgical operating history （ OR = 1. 753, 95% CI O. 037-2. 809, P = 0. 026 ） and venous cetheterization （ OR = 1. 213, 95% CIO. 092-2. 959 ,P =0.042） were independent risk facors of CSE. Age（ OR = 1. 187, 95 % C10. 092-2. 959, P = 0.021 ） , pneumonia （ OR = 7.081,95 % CI 2. 053-688. 270, P = 0. 029 ） and blood procalcitonin（ OR = 2. 098,95% CI 1. 313-58. 799, P = 0. 037 ） were independent risk factors 30-day mortality of CRE infection. Conclusion Clinicians should pay high attention to the the risk factors for acquisition and mortality of carbapenem-resistant Enterobacteriaceae infection.

关 键 词：肠杆科细菌 碳青霉烯类抗生素 耐药 危险因素 

分 类 号：R978.1[医药卫生—药品]