颅内碳青酶烯类耐药与敏感肠杆菌科细菌感染的治疗及其经济学损失分析

Treatment of intracranial infection caused by carbapenem-resistant or sensitive Enterobacteriaceaeand economic loss

目的探讨碳青酶烯类耐药肠杆菌(CRE)和碳青酶烯类敏感肠杆菌(CSE)颅内感染治疗效果和直接经济损失的差异,分析颅内感染治疗效果的影响因素。方法采用回顾性调查方法,选取医院2014年1月-2015年12月CRE和CSE颅内感染患者,按1∶1比例配对,将患者分为CRE组和CSE组,各12例;比较CRE和CSE颅内感染治疗效果和住院费用的差异,分析耐药情况和抗菌药物联合使用对治疗效果的影响。结果发现CRE颅内感染治愈率为41.67%,CSE颅内感染治愈率为91.67%,两组差异有统计学意义(P<0.05);CRE组每床日医疗费用为7 008.82元,CSE组每床日医疗费用为2 777.75元,两组差异有统计学意义(Z=-2.252,P=0.024);碳青酶烯类联合其他药物治疗CRE颅内感染是常见的组合,治愈率66.67%,CSE颅内感染治疗以碳青酶烯类单药治疗为主,治愈率为91.67%;鞘内局部注射抗菌药物局部治疗,未提高CRE颅内感染的治愈率。结论 CRE颅内感染可明显增加患者的经济损失,临床治疗效果较CSE低,临床应积极采取有效措施进行预防控制。

OBJECTIVE To explore the effects of treatment of intracranial infection caused by carbapenem-resistant Enterobacteriaceae（CRE）and carbapenem-sensitive Enterobacteriaceae（CSE）,observe the difference in the direct economic loss,and analyze the influencing factors for the effects of treatment of the intracranial infection.METHODS By means of retrospective survey,the patients with CRE and CSE intracranial infection who were treated in hospitals from Jan 2014 to Dec 2015 were enrolled in the study and divided into the CRE group and the CSE group in a 1：1ratio,with 12 cases in each group.The therapeutic effects and hospitalization costs were observed and compared between the patients with CRE intracranial infection and the patients with CSE intracranial infection,and the influence of the drug resistance and combined use of antibiotics on the therapeutic effects was observed.RESULTS The cure rate of the CRE intracranial infection was 41.67%,the cure rate of the CSE intracranial infection was 91.67%,and there was significant difference between the two groups（P〈0.05）.The medical cost per bed day was 7 008.82 yuan in the CRE group,2 777.75 yuan in the CSE group,and there was significant difference between the two groups（Z=-2.252,P=0.024）.The carbapenems combined with other drugs was the most common combination for the treatment of CRE intracranial infection,with the cure rate 66.67%.The carbapenems monotherapy was dominant among the treatment of the CRE intracranial infection,with the cure rate91.67%.The intrathecal local injection of antibiotics could not raise the cure rate of the CRE intracranial infection. CONCLUSIONThe CRE intracranial infection can remarkably increase the economic loss,the clinical therapeutic effect of the CRE is lower than that of the CSE.It is necessary for the hospital to take effective prevention measures.