重症监护病房耐碳青霉烯类肠杆菌科细菌感染的危险因素分析

目的探讨重症监护病房耐碳青霉烯类肠杆菌科细菌感染(carbapenem-resistant Enterobacteriaceae,CRE)的危险因素。方法选取宁波市医疗中心李惠利医院2016年1月—2017年12月入住重症监护病房耐碳青霉烯类肠杆菌科细菌感染患者66例作为观察组,同期入院的碳氢霉烯类药物敏感患者146例作为对照组,收集患者的人口学特征、临床基本数据、病情严重程度评分、侵入性操作等一般资料,采用回顾性分析方式,明确2组间的单因素差异,并采用多因素逻辑回归分析,明确重症监护病房耐碳青霉烯类肠杆菌科细菌感染的危险因素。结果重症监护病房耐碳青霉烯类肠杆菌感染的发生率为31.13%(66/212);66株耐碳青霉烯类肠杆菌科细菌感染中有:肺炎克雷伯菌39株(59.09%)、大肠埃希菌12株(18.18%)、阴沟肠杆菌11株(16.67%)、产气肠杆菌4株(6.06%);CRE感染患者的APACHEⅡ评分、GCS评分、侵入性操作及感染前用药与对照组比较差异有统计学意义(均P<0.05);CRE感染患者的危险因素包括:APACHEⅡ评分、手术、气管插管、感染前应用抗菌药物(OR>1;均P<0.05);而GCS评分为其保护性因素(OR<1;P<0.01)。结论重症监护病房耐碳青霉烯类肠杆菌科细菌感染的危险因素主要包括APACHEⅡ评分、手术、气管插管及感染前应用抗菌药物,GCS评分是保护性因素,针对APACHEⅡ评分高、手术并进行气管插管的昏迷患者,有应用抗菌药物治疗史的患者尤其应该加以重视并进行及早筛查。

Analysis of risk factors for bacterial infection of Enterobacteriaceae resistant to carbapenem in intensive care unit

Objective To investigate the risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care unit (ICU). Methods From January 2016 to December 2017, 66 patients with Enterobacteriaceae infection resistance to carbapenem were selected as the main observation object (observation group), and carbapenem drug sensitivity in the same period of admission was selected as the main observation object (observation group). The demographic characteristics of 146 patients (control group) were collected. The basic clinical data, severity score, invasive operation and other general data were compared. The single factor difference between the two groups was determined by retrospective analysis, and multivariate Logistic regression analysis was used to identify the risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care unit (ICU). Results The incidence of carbapenem-resistant Enterobacteriaceae infection in intensive care unit was 31.13% (66/212). Among 66 strains of Enterobacteriaceae, 39 were Klebsiella pneumoniae (59.09%), 12 were Escherichia coli (18.18%), 11 were Enterobacter cloacae (16.67%), 4 were Enterobacter aerogenes (6.06%). There were significant differences in APACHE Ⅱ score, invasive operation and drug use before infection between patients with CRE infection and control group (P<0.05). The risk factors of APACHE Ⅱ score, operation, and endotracheal intubation were significantly different from those in control group (all P<0.05). Antibiotics were used before infection (OR>1; all P<0.05), and GCS score was the protective factor (OR<1; P<0.01). Conclusion The risk factors of Enterobacteriaceae infection in intensive care unit mainly included Apache Ⅱ score, operation, tracheal intubation and antibiotics before infection as protective factors, and Apache Ⅱ score was high. Severe coma patients undergoing surgery and endotracheal intubation should be given more attention and early screening if they have a history of antibiotic therapy.