ICU患者耐碳青霉烯类肠杆菌科易感因素及预后影响因素分析

目的分析该院重症医学科耐碳青霉烯类肠杆菌科细菌(CRE)感染患者的易感因素及预后相关影响因素,为CRE的防治及感染患者预后判断提供依据。方法采用回顾性方法选取该院2014年7月1日至2018年7月1日重症医学科CRE感染患者,碳青霉烯类敏感肠杆菌科细菌(CSE)患者及非发酵菌细菌感染患者各177例作为研究对象,收集包括年龄、性别、菌株来源、是否合并其他微生物感染、抗菌药物使用情况等资料,分析患者的CRE易感因素,通过比较生存及死亡患者资料,分析影响CRE感染患者预后的危险因素。结果177例CRE感染患者中,132例存活,45例死亡,病死率为25%;CRE对碳青霉烯类抗菌药物的耐药率约为90%,对大多数临床常用抗菌药物高度耐药;CRE的易感因素包括菌株检出时机(入住ICU后)、联合使用抗菌药物;Logistic回归分析结果显示,年龄≥60岁、既往有高血压病史是重症医学科CRE感染患者预后的独立影响因素。结论高龄、入住ICU、呼吸道感染、入院天数10~<30 d、联合使用抗菌药物是CRE的易感因素,年龄≥60岁、既往高血压病史是医院感染患者死亡的独立影响因素,临床应对有高危因素的患者进行定期CRE定植筛查,加强对多重耐药菌的隔离等防控措施。

Analysis of susceptibility factors and prognostic factors for carbapenems resistant enterobacteriaceae in ICU patients

Objective To analyze the susceptibility factors and prognostic factors of patients with carbapenems resistant enterobacteriaceae(CRE)infection in the intensive care department of the Second Affiliated Hospital of Kunming Medical University,so as to provide a basis for the prevention and treatment of CRE and prognosis judgment of patients with infection.Methods A retrospective method was used to select 177 cases with CRE from July 1,2014 to July 1,2018,177 cases with carbapenems sensitive enterobacteriaceae(CSE)infection and 177 cases with the fermentation bacteria infection as objects,collected data including age,gender,source of strain,whether merger other microbial infection,use of antibiotics,analyzed patients with CRE susceptible factors,by comparing the patients survival and death,to analyze the risk factors influencing the prognosis of patients with CRE infection.Results Among a total of 177 patients with CRE infection,132 survived,45 died,and the mortality rate was 25%.The drug resistance rate of CRE to carbapenems antibiotics was almost 90%,and it was highly resistant to most commonly used clinical antibiotics.The susceptible factors of CRE included the detection time of bacterial strain(after admission to ICU),and the combination of antibiotics.Logistic regression analysis results showed that aged 60 years old or more than 60 years old,previous history of hypertension were independent factors influencing the prognosis of patients with CRE infection in ICU.Conclusion Age,admission to the ICU,respiratory tract infection,the admission days(10-<30 d),combined use of antibiotics were the susceptible factors of CRE,aged 60 years old or more than 60 years old,previous history of hypertension were independent factors influencing the death of patients with hospital infection.Therefore,regular CRE colonization screening and isolation of multi-drug resistant bacteria should be carried out in patients with high risk factors.