耐万古霉素肠球菌医院感染的风险因素及预后分析

Analysis of Risk Factors and Prognosis of Nosocomial Infection by Vancomycin-resistant Enterococci

目的:分析某三甲医院耐万古霉素肠球菌(VRE)的院内感染情况,为防治VRE引起的院内感染提供参考。方法:选择某三甲教学医院2009～2017年所有VRE医院感染患者49例为观察组,另按1∶3比例随机选取同期同区域万古霉素敏感肠球菌(VSE)患者156例作为对照组,进行单因素及多因素Logistic回归分析。结果:49例VRE感染病例中,万古霉素耐药粪肠球菌9例(18. 37%),万古霉素耐药屎肠球菌40例(81. 63%)。单因素分析发现心血管与呼吸系统慢性疾病,气管切开/插管,合并其他细菌感染,分离VRE前接受碳青霉烯类、头孢菌素、氟喹诺酮、糖肽类,以及暴露于抗菌药物的数量与VRE感染相关。Logistics回归显示:住院期间实施气管切开/插管,以及感染之前使用两种以上抗菌药物是VRE感染的危险因素。结论:气管切开/插管和使用两种以上抗菌药物,是造成VRE感染的独立危险因素。临床需要加强感控措施,慎重联用抗菌药物,防治VRE的院内感染暴发。

Objective: To analyze the nosocomial infection by vancomycin-resistant Enterococcus( VRE) in a tertiary hospital and provide reference for prevention and treatment of nosocomial infection caused by VRE. Methods: A total of 49 patients with VRE hospital infection from 2009 to 2017 were selected as the case group. Another 156 patients with vancomycin-responsive Enterococci( VSE)at the same time in the same area were randomly selected as the control group. Univariate and multivariate logistic regression analysis were performed. Results: In the 49 cases of VRE infection,vancomycin-resistant Enterococcus faecalis( VREfa) was found in 9 cases(18. 37%) and vancomycin-resistant Enterococcus faecium(VREfm) in 40 cases(81. 63%). The univariate analysis revealed cardiovascular chronic respiratory disease,tracheotomy/intubation,other bacterial infections,treatment with carbopenems,cephalosporins,fluoroquinolones and glycopeptides and exposure to antibiotics before VRE isolation were all associated with VRE infection. The logistic regression showed that tracheotomy/intubation during hospitalization and the use of two or more antibiotics before infection were the risk factors for future VRE infection. Conclusion: Tracheotomy/intubation and the use of two or more antimicrobial agents are independent risk factors for VRE infection. Clinics need to strengthen the control measures and apply the combined antibiotics carefully in order to prevent the outbreaks of VRE nosocomial infection.