碳青霉烯耐药肠杆菌目细菌(CRE)定植率及其引起血流感染的危险因素研究  

Study on colonization rate of carbapenem-resistant enterobacteriales(CRE)and risk factors of CRE-induced bloodstream infection

作　　者：陈淑娟[1] Chen Shujuan(Affiliated Hospital of Putian University,Putian,Fujian 351100,China.)

机构地区：[1]莆田学院附属医院,福建莆田351100

出　　处：《齐齐哈尔医学院学报》2024年第18期1767-1771,共5页Journal of Qiqihar Medical University

摘　　要：目的分析碳青霉烯耐药肠杆菌目细菌(CRE)定植率及其引起血流感染的危险因素。方法选择2021年3月—2023年3月本院收治的384例感染高危接受CRE主动筛查患者,经CRE筛查显示阳性结果136例,CRE定植率为35.42%;以住院期间是否发生血流感染为依据,将136例CRE筛查阳性患者分为血流感染组(25例)与非血流感染组(111例)。分析CRE感染患者的科室分布、病原学检测情况,并采用单因素、多因素Logistic回归分析法分析CRE血流感染的危险因素。结果136例CRE阳性患者分布于14个科室,其中重症医学科63例,占比最高为46.32%,其次是血液病科27例,占比为19.85%;136例CRE阳性患者检出肺炎克雷伯菌115株,占比最高为84.56%,其次是大肠埃希菌10株,占比为7.35%;血流感染组中性粒细胞缺乏、放化疗、使用免疫抑制剂、使用糖皮质激素、抗生素使用≥2种、碳青霉烯类药物暴露史、中心静脉置管占比高于非血流感染组,气管切开率低于非血流感染组(P<0.05);多因素Logistic回归分析显示,中性粒细胞缺乏、使用糖皮质激素及碳青霉烯类抗生素暴露史是CRE血流感染发生的独立危险因素(P<0.05)。结论中性粒细胞缺乏、使用糖皮质激素及碳青霉烯类抗生素暴露史是CRE血流感染发生的独立危险因素,应早期识别以上危险因素,通过合理使用抗生素、糖皮质激素等,以降低CRE血流感染率。Objective To analyze the colonization rate of carbapenem-resistant enterobacteriales(CRE)and the risk factors of bloodstream infection.Methods A total of 384 patients with a high risk of infection who received active CRE screening from March 2021 to March 2023 were selected as study subjects.Of these,136 patients showed positive results after CRE screening,with a CRE colonization rate of 35.42%.Patients with positive CRE screening were divided into a bloodstream infection group(25 cases)and a non-bloodstream infection group(111 cases)based on the occurrence of bloodstream infection during hospitalization.The department distribution and etiological detection of patients with CRE infection were analyzed,and the risk factors for CRE bloodstream infection were analyzed using univariate and multivariate Logistic regression analysis.Results The 136 CRE-positive patients were distributed across 14 departments,with 63 cases in the intensive care department,accounting for 46.32%,and 27 cases in the hematology department,accounting for 19.85%.Among the 136 CRE-positive patients,115 strains of Klebsiella pneumoniae were detected,accounting for 84.56%,followed by 10 strains of Escherichia coli,accounting for 7.35%.The proportion of patients with neutrophil deficiency,undergoing radiotherapy and chemotherapy,using immune suppressants,using glucocorticoids,using two or more types of antibiotics,having a history of exposure to carbapenems,and with central vein catheterization was higher in the bloodstream infection group than in the non-bloodstream infection group.However,the rate of tracheotomy was lower in the bloodstream infection group(P<0.05).Multivariate Logistic regression analysis indicated that neutrophil deficiency,glucocorticoid use,and carbapenem antibiotic exposure are independent risk factors for CRE bloodstream infection(P<0.05).Conclusions Neutropenia,the use of glucocorticoids,and exposure to carbapenems are independent risk factors for CRE bloodstream infection.These risk factors should be identified early,and

关 键 词：碳青霉烯耐药肠杆菌 细菌定植 血流感染 危险因素 糖皮质激素 

分 类 号：R378.2[医药卫生—病原生物学]