某院2016—2021年耐碳青霉烯类肠杆菌目细菌感染危险因素分析  

Risk Factors Analysis of Carbapenem-resistant Enterobacterales in a Hospital in 2016—2021

作　　者：杨慧 郑国军[1] 陈敏[1] 韩雪 YANG Hui;ZHENG Guojun;CHEN Min;HAN Xue(Department of Clinical Laboratory,The Third People's Hospital of Changzhou,Changzhou Jiangsu 213000,China)

机构地区：[1]常州市第三人民医院检验科,江苏常州213000

出　　处：《中国卫生标准管理》2022年第12期156-162,共7页China Health Standard Management

摘　　要：目的回顾性分析耐碳青霉烯类肠杆菌目细菌(carbapenemresistant enterobacterales,CRE)感染的潜在危险因素。方法收集常州市第三人民医院2016年1月—2021年12月的肠杆菌目细菌共2645株,CRE 103株。采用全自动微生物鉴定和药敏仪检测肠杆菌目细菌的药敏结果;多因素Logistic回归分析CRE感染的潜在危险因素。结果CRE菌株主要来源于痰49株(47.57%),其次为尿26株(25.24%)、体液11株(10.68%)、全血10株(9.71%)等。CRE菌株主要来源于重症医学科29株(28.16%),其次为泌尿外科17株(16.50%)、感染科14株(13.59%)、呼吸内科11株(10.68%)、肝胆外科10株(9.71%)。肠杆菌目细菌对头孢唑啉、氨苄西林、哌拉西林、萘啶酸、头孢呋辛酯及左氧氟沙星耐药率较高,耐碳青霉烯类肠杆菌目细菌检出率逐年上升。多因素回归分析结果显示患者≥70岁、机械通气、应用抗菌药物时长≥2周、住院时长≥2周和携带其他耐药菌是CRE感染的独立危险因素。结论加强对重点科室和重点人群的病原菌药敏结果的检测分析,科学规范评估患者病情,减少导致感染CRE的相关性操作。Objective To explore the risk factors for carbapenemresistant enterobacterales(CRE)infection in a hospital in Changzhou.Methods A total of 2645 strains of enterobacterales were isolated in the third people’s hospital of Changzhou from Jan 2016 to Dec 2021,including 103 strains of carbapenem-resistant enterobacterales(CRE).The distribution characteristics and drug resistance of enterobacterales were analyzed by using an automatic microbial identification system and drug susceptibility experiments.The risk factors of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis.The main strains of CRE were 29(28.16%)from ICU,17(16.50%)from urology department,14(13.59%)from infectious department,11(10.68%)from respiratory department and 10(9.71%)from hepatobiliary department.The isolated enterobacterales was highly resistant to cefazolin,ampicillin,piperacillin,nalidixic acid cefuroxime axetil and levofloxacin.The resistance rates to imipenem and meropenem increased significantly,and isolation rate of CRE increased year by year.Results A total of 2645 strains of enterobacterales were collected,53.61%(1418 strains)were Escherichia coli in the past six years.The main strains of CRE were sputum 49(47.57%),urine 26(25.24%),body fluid 11(10.68%)and whole blood 10(9.71%).Isolation rate of CRE increased year by year.Multivariate analysis showed that patients≥70 years old,mechanical ventilation,duration of antibiotics≥2 weeks,length of hospital stay≥2 weeks and carrying other drug-resistant bacteria were independent risk factors for CRE infection.Conclusions Strengthen the detection and analysis of drug sensitivity results of pathogenic bacteria in key departments and key populations,scientifically and standardized evaluation of patients’conditions,and reduce the related operations leading to infection of CRE.

关 键 词：病原菌 肠杆菌目细菌 药敏试验 耐药性 耐碳青霉烯类 危险因素 

分 类 号：R515[医药卫生—内科学]