临床患者碳青霉烯类耐药肠杆菌目细菌感染及死亡危险因素分析  

Analysis of risk factors of carbapenem-resistant Enterobacterales infection and death in clinical patients

作　　者：只棣媛 陈倩倩 孔海芳 李静[1] 田彬[1] 胡志东[1] ZHI Di-yuan;CHEN Qian-qian;KONG Hai-fang;LI Jing;TIAN Bin;HU Zhi-dong(Department of Medical Laboratory,General Hospital,Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院医学检验科,天津300052

出　　处：《天津医科大学学报》2023年第5期536-542,共7页Journal of Tianjin Medical University

摘　　要：目的:探究临床患者碳青霉烯类耐药肠杆菌目(CRE)细菌感染及感染患者死亡相关危险因素,并对CRE感染进行预测分析。方法:回顾性分析2021年4月—11月112例CRE感染患者的临床资料,以同期112例碳青霉烯类敏感肠杆菌目细菌(CSE)感染患者作为对照组,分析CRE菌株分布特征及耐药性,单因素分析住院患者CRE感染的危险因素及感染CRE患者死亡的危险因素。通过二元Logistic回归分析方法,分析患者CRE感染的独立危险因素及感染CRE患者死亡的独立危险因素。并将独立危险因素中的连续变量进行受试者工作特征(ROC)曲线分析,以评估该因素预测住院患者感染CRE的效能。结果:CRE感染多见于重症监护病房(ICU),以呼吸道标本为主,肺炎克雷伯菌最常见。单因素分析显示,泌尿系统疾病(χ^(2)=4.074,P<0.05)、实体恶性肿瘤(χ^(2)=11.687,P<0.05)、气管插管机械辅助通气(χ^(2)=32.749,P<0.05)、气管切开(χ^(2)=30.701,P<0.05)、留置静脉导管(χ^(2)=14.613,P<0.05)、留置动脉导管(χ^(2)=6.298,P<0.05)、尿管(χ^(2)=4.464,P<0.05)、胃管(χ^(2)=15.076,P<0.05)、碳青霉烯类药物暴露史(χ^(2)=39.703,P<0.05)、β内酰胺酶抑制剂暴露史(χ^(2)=58.810,P<0.05)、非碳青霉烯类药物联合用药(χ^(2)=39.938,P<0.05)、三四代头孢暴露史(χ^(2)=5.098,P<0.05)、入院时急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(U=4367.000,P<0.05)、APACHEⅡ评分≥11分(χ^(2)=4.210,P<0.05)、中性粒细胞百分数(t=12.648,P<0.05)、淋巴细胞百分数(U=4205.000,P<0.05)、粒淋比(U=3241.000,P<0.05)、凝血酶原时间(t=7.802,P<0.05)、活化部分凝血活酶时间(U=3662.000,P<0.05)、D-二聚体(U=2616.000,P<0.05)等与住院患者感染CRE相关。年龄(U=625.500,P<0.05)、年龄≥78岁(χ^(2)=17.824,P<0.05)、心脑血管疾病(χ^(2)=9.737,P<0.05)、留置静脉导管(χ^(2)=5.379,P<0.05)、尿素(U=606.000,P<0.05)、肌酐(U=788.000,P<0.05)、尿酸(U=714.500,P<0.05)等因素Objective:To explore the risk factors of carbapenem-resistant Enterobacterales(CRE)infection in clinical patients and death of infected patients,and to analyze the predictive value of CRE infection.Methods:A retrospective method was used to select the clinical data of 112 cases with CRE from April to November 2021.And 112 cases with carbapenem-sensitive Enterobacterales(CSE)infection in the same period were taken as the control group.The distribution and drug resistance of CRE strains was analyzed.And the risk factors of CRE infection and death of infected patients were analyzed by univariate analysis.The independent risk factors of CRE infection and death of infected patients were analyzed by binary Logistic regression analysis.The continuous variables among independent risk factors were analyzed using the receiver operating characteristic(ROC)curve to evaluate the effectiveness of this factor in predicting CRE infection in hospitalized patients.Results:CRE infection was common in intensive care unit(ICU),mainly in respiratory tract specimens,and Kleb-siella pneumoniae was the most common pathogen.A univariate analysis showed that,urinary system diseases(χ^(2)=4.074,P<0.05),solid malignancy(χ^(2)=11.687,P<0.05),endotracheal intubation and mechanical ventilation(χ^(2)=32.749,P<0.05),tracheotomy(χ^(2)=30.701,P<0.05),indwelling venous catheter(χ^(2)=14.613,P<0.05),indwelling arterial catheter(χ^(2)=6.298,P<0.05),urinary catheter(χ^(2)=4.464,P<0.05),gastric tube(χ^(2)=15.076,P<0.05),exposure history of Carbapenem(χ^(2)=39.703,P<0.05),exposure history ofβ-lactamase inhibitors(χ^(2)=58.810,P<0.05),non carbapenem combination therapy(χ^(2)=39.938,P<0.05),exposure history of third and fourth generation cephalosporins(χ^(2)=5.098,P<0.05),Acute Physiology and Chronic Health evaluation Scoring SystemⅡ(APACHEⅡ)at admis sion(U=4367.000,P<0.05),APACHEⅡ≥11(χ^(2)=4.210,P<0.05),neutrophil percentage(t=12.648,P<0.05),lymphocyte percentage(U=4205.000,P<0.05),granulocyte to lymphocyte ratio(U=3241.000,P<0.05),p

关 键 词：碳青霉烯类耐药肠杆菌目 住院患者 分布特征 危险因素 

分 类 号：R446[医药卫生—诊断学]