耐碳青霉烯类肠杆菌科细菌的感染因素分析  

Analysis of risk factors of Carbapenem-resistant enterobacteriaceae bacteria infection

作　　者：周仕丹[1] 刘春来[1] 李妍 曹海燕[1] 晏辉钧 庄志辉[1] ZHOU Shi-dan;LIU Chun-lai;LI Yan;CAO Hai-yan;YAN Hui-jun;ZHUANG Zhi-hui(Huizhou Municipal Central Hospital,Huizhou 516001,Guangdong;Department o f Microbiology,Zhongshan Medical College,Sun Yat-sen University,Key Laboratory of Tropical Disease Control(Sun Yat-Sen University),Ministry of Education,Guangzhou 510080,Guangdong)

机构地区：[1]惠州市中心人民医院,广东惠州516001 [2]中山大学中山医学院微生物学教研室、中山大学热带病防治研究教育部重点实验室,广东广州510080

出　　处：《中药与临床》2019年第3期29-33,共5页Pharmacy and Clinics of Chinese Materia Medica

基　　金：惠州市科技计划项目(2017Y002)。

摘　　要：目的:分析耐碳青霉烯类肠杆菌科细菌(CRE)的感染因素、医院感染情况与临床预后,为临床医生治疗CRE感染的患者和医院感染管理部防控院内CRE播散提供参考依据。方法:按照1:2成组匹配原则,收集医院2012-2018年47例CRE感染患者,94例碳青霉烯类敏感的肠杆菌科细菌(CSE)感染患者;回顾性分析患者的基本资料、临床诊疗、抗菌药物使用与医院感染情况等,探讨CRE感染的危险因素。结果:47位患者检出50株CRE,主要分布在烧伤外科(10例)、神经外科(8例);感染来源最高的是烧伤感染(31.25%),其次是下呼吸道感染(27.08%),第三位尿路感染(22.92%);多因素分析显示,使用呼吸机、气管切开、临床结局是CRE检出的独立危险因素。结论:烧伤和颅脑损伤的危重症患者是CRE感染的易感人群;长时间使用呼吸机、长期处于气管切开状态的患者易感染CRE;对感染CRE患者,临床医务人员要规范有创操作、合理使用抗菌药物、为患者提供优质护理等,使CRE患者好转或治愈,或者减少CRE在患者体内的定植。Objective:Through analysis of Carbapenem-resistant enterobacteriaceae bacteria infection on its risk factors,related nosocomial infection characteristic and prognosis to provide a reference for clinical therapy and infection control method.Method:According to 1:2 group matching principle,47 Carbapenem-resistant enterobacteriaceae (CRE) bacteria infection cases and 94 Carbapenem-sensitive enterobacteriaceae (CSE) bacteria infection cases were collected from 2012 to 2018.Retrospective analysis was applied on patients’ basic information,clinical treatment,antibacterial drugs application and nosocomial infection occurrence to risk factors of CRE bacteria infection.Result:50 CRE strains were found in 47 patients,most of which were from Burn Surgery (10 cases) and neurosurgery (8 cases).The burn infection patients showed highest rate of CRE (31.25%).Respiratory tract infection patients came second (27.08%),and urinary tract infection ranked the third (22.92%) place.Multivariate analysis suggested that respirator application,tracheotomy and clinical outcome were independent risk factors of CRE infection.Conclusion:Patients suffer from brain injury or burn are susceptible population of CRE infection.Patients with long-term respirator application or tracheotomy situation are vulnerable to CRE infection.Regulating invasive manipulation and antibiotics therapy,and providing high-quality nursing for patients with CRE infection may be beneficial to improvement,recovery and decreasing of CRE colonization.

关 键 词：耐碳青霉烯类肠杆菌科细菌 医院感染 危重症患者 感染因素 

分 类 号：R378[医药卫生—病原生物学]