ICU患者肠道定植耐碳青霉烯类肠杆菌继发感染的危险因素及预后分析  

Risk factors and prognosis of secondary infection of intestinal colonized carbapenem-resistant enterobacter in ICU patients

作　　者：刘奇 吴伟平[1] 黄黎俐[1] 蓝俊杰 LIU Qi;WU Wei-ping;HUANG Li-li;LAN Jun-jie(Lishui People's Hospital,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院,浙江323000

出　　处：《中国卫生检验杂志》2023年第17期2090-2093,共4页Chinese Journal of Health Laboratory Technology

基　　金：丽水市公益性技术应用研究计划项目(2023GYX50)。

摘　　要：目的 分析重症监护室(ICU)肠道定植耐碳青霉烯类肠杆菌(CRE)患者住院过程中CRE的感染及预后情况,探究CRE由定植转变为感染的危险因素。方法 选取某三甲医院2020年1月—2022年8月肠道定植CRE的重症监护室患者,根据是否发生CRE感染分为CRE感染组(35例)和对照组(40例)。回顾性调查2组患者的临床资料,分析感染及预后情况,通过统计学方法对比2组间的差别,并分析CRE肠道定植继发感染的独立危险因素。结果 75例患者中,肠道定植的主要是耐碳青霉烯肺炎克雷伯菌(CR-KPN)56例(74.7%)。CRE感染主要发生在下呼吸道,其次为血流和尿路。碳青霉烯类抗菌药物暴露史和中心静脉置管是肠道定植CRE患者继发CRE感染的独立危险因素(P<0.05)。CRE感染组的死亡率高于对照组(P<0.05)。结论 对于肠道定植CRE患者,在临床治疗上应注意碳青霉烯类药物的合理使用和中心静脉置管术后的护理和消毒。Objective This paper aims to analyze the infection and prognosis of carbapenem-resistant enterobacter intestinalis(CRE) patients in intensive care unit(ICU) during hospitalization, so as to explore the risk factors of CRE transforming from colonization to infection. Methods ICU patients with intestinal CRE implantation from January 2020 to August 2022 in a Grade 3A hospital were selected and divided into CRE infection group(35 cases) and control group(40 cases) according to the incidence of CRE infection. Clinical data of the two groups were retrospectively investigated, infection and prognosis were analyzed, the differences between the two groups were statistically compared, and independent risk factors of secondary infection caused by intestinal colonization of CRE were analyzed. Results Among the 75 patients in the two groups, carbapenem-resistant Klebsiella pneumoniae(CR-KPN) was the mainly colonized in intestinal tract in 56 cases(74.7%). CRE infection occurred mainly in the lower respiratory tract, followed by blood flow and urinary tract. History of exposure to carbapenems and central vein catheterization were independent risk factors for secondary CRE infection in intestinal colonized CRE patients(P<0.05). Mortality was higher in the CRE infection group than in the control group(P<0.05). Conclusion For the patients with intestinal colonized CRE, attention should be paid to the rational use of carbapenems and the nursing and disinfection after central vein catheterization.

关 键 词：耐碳青霉烯类肠杆菌 定植 感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]