肠道耐碳青霉烯类肠杆菌科细菌临床特征及危险因素分析

Clinical characteristics and risk factors of carbapenem-resistant Enterobacteriaceae

目的了解患者肠道耐碳青霉烯类肠杆菌科细菌(CRE)的发生情况并探讨其危险因素,为临床CRE的防控提供依据。方法对2021年8月31日-2022年2月28日在南方医科大学珠江医院入院就诊患者的大便进行CRE筛查;将CRE筛查阳性≥1次患者纳入阳性组,将大便CRE筛查阴性患者纳入阴性组,分析筛查CRE阳性的危险因素。结果9615例患者肠道CRE筛查,阳性率为4.9%(475/9615);阳性率较高的科室分别为急诊ICU病区(29.2%,12/41)、新生儿ICU病区(20.0%,13/65)、ICU病区(15.8%,3/19)、儿科血液肿瘤专科(14.6%,18/123)、新生儿专科(14.0%,6/43);475例CRE筛查阳性患者共培养出493株CRE菌株,以大肠埃希菌(49.9%,246/493)和肺炎克雷伯菌(45.6%,225/493)为主;大肠埃希菌以产金属酶为主(93.9%,231/246),肺炎克雷伯菌主要产丝氨酸酶(48.4%,109/225)和金属酶(45.8%,103/225);产丝氨酸酶的菌株对阿米卡星、氨曲南的耐药率明显高于产金属酶的菌株,差异均有统计学意义(χ^(2)=280.803、179.141,P均<0.05);年龄1 d~4岁(OR=2.254,95%CI=1.352~3.758),有肠外营养史(OR=2.196,95%CI=1.216~3.968)、有碳青霉烯类(OR=2.818,95%CI=1.728~4.594)、喹诺酮类(OR=1.892,95%CI=1.054~3.398)、β-内酰胺类复合药物(OR=1.672,95%CI=1.025~2.729)暴露史是肠道CRE筛查阳性的独立危险因素(P均<0.05)。结论对CRE高流行率病房患者,尤其是年龄1 d~4岁、有肠外营养或碳青霉烯类、喹诺酮类、β-内酰胺类复合药物使用史的患者,建议加强肠道CRE筛查,可协助临床尽早采取有效的防控措施,预防交叉传播和院内感染。

Objective To investigate the prevalence of carbapenem-resistant Enterobacteriaceae(CRE)and its risk factors in patients,and provide scientific basis for the prevention and control of CRE.Methods A retrospective study was carried out among patients admitted to the hospital between Aug.31,2021 to Feb.28,2022;patients with≥1 positive stool CRE screening were then included in the positive group and those with negative stool CRE screening were included in the negative group,and risk factors for intestinal CRE positivity were analyzed.Results A total of 9615 patients were screened for CRE,and the positive rate was 4.9%(475/9615).The departments with the highest positive rate of intestinal CRE screening were Emergency ICU(29.2%,12/41),Neonatal ICU(20.0%,13/65),ICU(15.8%,3/19),Pediatric Hematological Oncology(14.6%,18/123)and Neonatal Specialty(14.0%,6/43).A total of 493 CRE strains were isolated from 475 CRE positive patients;Escherichia coli(49.9%,246/493)and Klebsiella pneumoniae(45.6%,225/493)were the main pathogens,Escherichia coli mainly produced metalloenzymes(93.9%,231/246),while Klebsiella pneumoniae mainly produced serine enzymes(48.4%,109/225)and metalloenzymes(45.8%,103/225).The resistance rates of serine-producing strains to Amikacin and Aztreonam were significantly higher than that of metalloenzyme-producing strains(χ^(2)=280.803,179.141;all P<0.05).Age from 1 day to 4 years old(OR=2.254,95%CI=1.352-3.758),history of parenteral nutrition(OR=2.196,95%CI=1.216-3.968),carbapenems(OR=2.818,95%CI=1.728-4.594),quinolones(OR=1.892,95%CI=1.054-3.398),and exposure toβ-lactam compound drugs(OR=1.672,95%CI=1.025-2.729)were independent risk factors for positive intestinal CRE screening(all P<0.05).Conclusions It was recommended to strengthen the screening of intestinal CRE in patients with high prevalence of CRE,especially in patients aged 1 day to 4 years old,with parenteral nutrition or carbapenems,quinolones,andβ-lactams.Effective prevention and control measures should be taken as soon as possible to prevent cross-transmission and nosocomial infection.