耐碳青酶烯类肠杆菌科细菌血流感染的临床特征分析及预后  

Clinical characteristics and prognostic study of bloodstream infections caused by carbapenem-resistant Enterobacteriaceae

作　　者：禄梦笛 凌勇 叶龙 张鑫强 白雪皎 LU Mengdi;LING Yong;YE Long;ZHANG Xinqiang;BAI Xuejiao(Department of Clinical Laboratory,Guangdong Provincial People’s Hospital,Southern Medical University/Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院/广东省医学科学院检验科,广州510080

出　　处：《临床与病理杂志》2024年第4期548-554,共7页Journal of Clinical and Pathological Research

摘　　要：目的:耐碳青酶烯类肠杆菌科(carbapenase-resistant Enterobacteriaceae,CRE)血流感染目前已经成为临床面临的严峻挑战。本文通过探讨医院内CRE血流感染的临床特征及其死亡的危险因素,为其感染控制提供依据。方法:收集广东省人民医院2013年1月至2022年12月122例CRE血流感染患者28 d内预后的临床资料,采用单因素和多因素logistics回归分析CRE血流感染患者预后的临床危险因素。结果:122例CRE血流感染患者中,67例存活,55例死亡。检出的病原菌前3位依次为肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌。单因素分析结果显示:年龄、患有基础疾病、侵入性操作和抗菌药物使用情况及重症监护室入住情况是导致CRE血流感染预后不良的重要危险因素(均P<0.05)。多因素logistic回归分析显示:感染性休克(OR=4.655,95%CI 1.118~19.385,P<0.05)是导致CRE血流感染患者28 d内死亡的独立危险因素。结论:伴有感染性休克的患者更容易发生CRE血流感染,临床应加强对此类患者的重视并进行及早筛查,有效控制血流感染的发生。Objective:Bloodstream infections caused by carbapenem-resistant Enterobacteriaceae(CRE)have become a serious clinical challenge.This study aims to explore the clinical characteristics of hospital-acquired CRE bloodstream infections and the risk factors associated with mortality,providing a basis for infection control.Methods:Clinical data from patients with CRE bloodstream infections treated at Guangdong Provincial People’s Hospital between January 2013 and December 2022 were collected to analyze the 28-day prognosis.Univariate and multivariate logistic regression analyses were applied to identify clinical risk factors for the prognosis of patients with CRE bloodstream infections.Results:Among 122 patients with CRE bloodstream infections,67 survived and 55 died.The pathogens identified were primarily Klebsiella pneumoniae,Escherichia coli,and Enterobacter cloacae.Univariate analysis suggested that age,underlying diseases,invasive procedures,use of antibiotics,and intensive care unit admission were significant risk factors for poor prognosis in CRE bloodstream infections(all P<0.05).Multivariate logistic regression analysis suggested that septic shock(OR=4.655,95%CI 1.118 to 19.385,P<0.05)was an independent risk factor for 28-day mortality in patients with CRE bloodstream infections.Conclusion:Patients with septic shock are more likely to develop CRE bloodstream infections.Clinicians should pay close attention to these patients,conduct early screenings,and effectively control the occurrence of bloodstream infections.

关 键 词：耐碳青霉烯类肠杆菌科 血流感染 预后危险因素 

分 类 号：R515[医药卫生—内科学]