耐碳青霉烯类肠杆菌目细菌血流感染病原学及预后危险因素  

Etiological characteristics of carbapenem-resistant Enterobacteriaceae bloodstream infection and risk factors for prognosis

作　　者：刘洋 陆燕飞 张晓慧 夏文颖 LIU Yang;LU Yan-fei;ZHANG Xiao-hui;XIA Wen-ying(The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院检验学部,江苏南京210029

出　　处：《中华医院感染学杂志》2022年第14期2081-2084,共4页Chinese Journal of Nosocomiology

基　　金：国家临床检验重点专科建设基金资助项目;江苏省实验诊断学重点实验室基金资助项目(ZDXKB2016005)。

摘　　要：目的探讨医院耐碳青霉烯类肠杆菌目细菌(CRE)血流感染(BSI)患者的病原学特征及预后危险因素。方法回顾性分析2015年1月-2021年12月江苏省人民医院诊断为CRE-BSI 228例患者的临床资料,根据患者30 d生存情况,分为生存组108例、死亡组120例。分析细菌检出率、药物敏感性结果和患者临床特征,应用Logistic回归分析CRE-BSI的预后危险因素。结果BSI-CRE菌株主要来源于重症监护病房(ICU)115株占比50.44%,肺炎克雷伯菌是临床最常见CRE-BSI病原菌,占比88.59%,其对大部分抗菌药物耐药率均>70.00%;单因素分析显示年龄≥60岁、入住ICU、气管切开、机械通气、动脉静脉置管和血液透析与患者病死相关(P<0.05),Logistic回归显示年龄、机械通气和血液透析是CRE-BSI患者病死的危险因素(P<0.05)。结论本研究表明CRE-BSI患者存在高龄化、高病死率的特点;年龄、机械通气和血液透析是CRE-BSI预后不良的危险因素;临床可通过主动筛查,早期监测潜在传染源以降低死亡风险。OBJECTIVE To explore the etiological characteristics of patients with carbapenem-resistant Enterobacteriaceae(CRE) bloodstream infection(BSI) and analyze the risk factors for prognosis. METHODS The clinical data of 228 patients who were diagnosed with CRE-BSI in Jiangsu Province Hospital from Jan 2015 to Dec 2021 were retrospectively analyzed and divided into the survival group with 108 cases and the death group with 120 cases according to the 30-day survival status. The isolation rates of pathogens, results of drug susceptibility testing and clinical characteristics of the patients were observed, and logistic regression analysis was performed for the risk factors for prognosis of the patients with CRE-BSI. RESULTS Among the BSI-CRE strains, 115(50.44%) were isolated from intensive care unit(ICU), Klebsiella pneumoniae was the most common pathogen causing CRE-BSI, accounting for 88.59%, and the drug resistance rate to most antibiotics was more than 70.00%. Univariate analysis showed that the no less than 60 years of age, ICU stay, tracheotomy, mechanical ventilation, arteriovenous catheterization and hemodialysis were associated with the mortality of the patients(P<0.05). Logistic regression analysis indicated that age, mechanical ventilation and hemodialysis were the risk factors for mortality of the patients with CRE-BSI(P<0.05). CONCLUSION The patients with CRE-BSI are characterized by the advanced age and high mortality rate. The age, mechanical ventilation and hemodialysis are the risk factors for the poor prognosis of the patients with CRE-BSI. It is necessary for the hospital to conduct active screening and monitor the infection sources in early stage so as to reduce the risk of death.

关 键 词：肠杆菌目 碳青霉烯耐药 血流感染 临床特征 危险因素 

分 类 号：R378.2[医药卫生—病原生物学]