碳青霉烯耐药肠杆菌科细菌定植转血流感染危险因素分析  

Risk factors analysis of bloodstream infection caused by colonized carbapenem-resistant Enterobacteriaceae

作　　者：吴苗苗 杨丹红[2] 潘红英[2] 李曦[3] 孙仁华[4] 黄益澄[2] WU Miaomiao;YANG Danhong;PAN Hongying;LI Xi;SUN Renhua;HUANG Yicheng(Graduate School,Bengbu Medical College,Bengbu 233000,China;不详)

机构地区：[1]蚌埠医学院研究生院,233000 [2]浙江省人民医院(杭州医学院附属人民医院)感染科 [3]浙江省人民医院(杭州医学院附属人民医院)检验科 [4]浙江省人民医院(杭州医学院附属人民医院)重症医学科

出　　处：《浙江医学》2022年第12期1300-1303,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技项目(2021KY452);浙江省人民医院科研基金资助项目(ZRY2020C010)。

摘　　要：目的探究碳青霉烯耐药肠杆菌科细菌(CRE)定植转血流感染的危险因素。方法选取2019年1月—2021年12月浙江省人民医院住院期间因感染高危而行CRE主动筛查阳性的198例患者,根据是否发生血流感染分为血流感染组(37例)和非血流感染组(161例)。回顾性分析两组患者的临床资料,并采用多因素logistic回归分析CRE定植转血流感染的危险因素。结果198例CRE阳性患者中,共检出肺炎克雷伯菌167株(84.34%)、大肠埃希菌15株(7.58%)、奇异变形杆菌8株(4.04%)、产气肠杆菌3株(1.52%)、阴沟肠杆菌5株(2.52%)。多因素分析显示:碳青霉烯类抗生素暴露史(OR=3.715,95%CI:1.003~13.761,P<0.05)、应用糖皮质激素(OR=3.073,95%CI:1.198~7.698,P<0.05)、中性粒细胞缺乏(OR=9.258,95%CI:2.894~29.614,P<0.01)是CRE定植转血流感染的独立危险因素。结论早期识别CRE血流感染的危险因素并对其进行干预,有助于把握抗菌药物治疗时机及优化治疗方案。Objective To explore the risk factors of bloodstream infections in colonized carbapenem-resistant Enterobacteriaceae(CRE).Methods A total of 198 patients admitted in Zhejiang Provincial People's Hospital from January 2019 to December 2021 who underwent active screening and identified as positive CRE infection were enrolled in the study,including 37 cases with bloodstream infection and 161 cases without bloodstream infection.The clinical data of the patients were collected,and the risk factors of CRE bloodstream infection were analyzed with univariate and multivariate logistic regression.Results Among the 198 CRE positive strains,there were 167 strains(84.34%)of Klebsiella pneumoniae,15 strains(7.58%)of Escherichia coli,8 strains(4.04%)of Proteus mirae,3 strains(1.52%)of Enterobacter aeriformis and 5 strain(2.52%)of Enterobacter cloacae.Multivariate logistic regression analysis showed that exposure history of carbapenems(OR=3.715,95%CI:1.003-13.761,P<0.05),glucocorticoid use(OR=3.073,95%CI:1.198-7.698,P<0.05)and neutropenia(OR=9.258,95%CI:2.894-29.614,P<0.01)were independent risk factors for bloodstream infection after CRE colonization.Conclusion Early identification of risk factors for bloodstream infection in CRE and corresponding intervention are of importance for timely antimicrobial therapy and optimization of therapeutic protocols.

关 键 词：碳青霉烯耐药肠杆菌科细菌 定植 血流感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]