重症监护病房中耐碳青霉烯类肠杆菌感染危险因素分析

Risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care unit

目的分析重症监护病房（ICU）中耐碳青霉烯类肠杆菌科细菌（CRE）感染的危险因素。方法回顾性分析北京大学人民医院重症监护病房2014年1—12月收治的190例重症患者的临床资料，根据是否存在ERE感染将患者分为CRE感染阳性组（26例）和CRE感染阴性组（164例）。，采用多因素Logistic回归分析ICU中CRE感染的危险因素。结果与CRE阴性组相比，CRE阳性组中患者来源科室为呼吸内科和急诊科占比例大[分别为34．6％（9／26）和23．1％（6／26），P〈0．001]，合并其他病原感染率高[92，3％（24／26）比75.0％（123／164），P=0．050]，住ICU时间长[22．00（12．75，44．75）d比6．00（4．00，9．75）d，P〈0．001]，外科手术次数少[0（0，1）次比1（0，1）次，P=0．005]，气管切开率高[26．9％（7／26）比6．1％（10／164），P=0．001]，机械通气时间长[15．50（4．50，40．75）d比3．00（1．00，6．00）d，P〈0．001]，中心静脉置管时间长[18．00（8．50，39．00）d比5．00（3．00，7．00）d，P=0．001]。其中，患者来源科室[比值比（OR）=0．750，95％置信区间（CI）：0．609～0．923，P=0．007]、住ICU时间（OR=0．866，95％CI：0．796～0．941，P=0．001）和机械通气时间（OR=0．927，95％CI：0．872～0．984，P=0．013）是ICU中CRE感染的独立危险因素。结论患者来源科室、住ICU时间和机械通气时间是ICU中CRE感染的独立危险因素。

Objective To analyze risk factors of earbapenem-resistant Enterobacteriaceae（CRE） infection in intensive care unit（ICU）. Methods Totally 190 critical patients from January to December 2014 in ICU of Peking University People＇s Hospital were retrospectively analyzed, all patients were divided into CRE positive group（26 cases） and CRE negative group（ 164 cases）. Clinical data were analyzed between groups. Multivariate logistic regression was used to analyze risk factors of CRE infections in ICU. Results In CRE positive group, patients came from respiratory medicine department 134. 6% （9/26） ] and emergency department 123.1% （6/26） ] took larger proportions（P 〈 0. 001 ） than CRE negative group, the ratio of co-infection with other pathogens was higher [92. 3% （24/26） vs 75.0% （ 123/164）, P = 0. 0501, length of ICU stay was longer [ 22.00 （ 12. 75, 44.75）d vs 6.00（4.00,9.75） d,P 〈0.001], operation times was less[0（0, 1） time vs 1 （0, 1） time, P =0. 005] , the ratio of traeheotomy rate was higher[26. 9% （7/26） vs 6. 1% （10/164） , P =0. 0011 , length of mechanical ventilation was longer [ 15.50 （4. 50,40. 75 ） d vs 3.00 （ 1.00,6. 00 ） d, P 〈 0. 001 ], length of central venous catberization was longer [ 18.00 （8.50,39.00） d vs 5.00 （3.00,7.00） d, P = 0. 001 ] than those in C RE negative group. Logistic regression analysis showed that the department where patients came from[ odds ratio（OR） = 0. 750, 95% confidence interval（CI） ：0. 609-0. 923, P = 0. 0071, length of ICU stay （ OR = 0. 866,95% CI： 0. 796- 0. 941, P = 0. 001 ） and length of mechanical ventilation （ OR = 0. 927,95% CI： 0. 872-0. 984, P = 0. 013 ） were independent risk factors of CRE infection in ICU. Conclusion The department where patients admited, length of ICU stay and length of mechanical ventilation are independent risk factors of CRE infection in ICU.