耐碳青霉烯类肠杆菌科医院感染患者预后的相关影响因素研究

Risk factors associated with prognosis of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections

目的探讨耐碳青霉烯类肠杆菌科医院感染患者预后的相关因素。方法收集2015年1月1日-2017年12月31日耐碳青霉烯类肠杆菌科(CRE)医院感染患者的基线资料,包括年龄、性别、医院感染部位、医院感染病原体、基础疾病、是否住ICU,是否手术;随访患者抗菌药物使用情况,合并其他病原体感染及生存状况,以诊断医院感染CRE至治愈出院或死亡的时间为研究对象的生存时间,运用COX回归模型进行单因素及多因素分析,筛选影响CRE医院感染患者预后的影响因素。结果研究期间共纳入医院感染CRE 499例,444例存活,55例死亡,病死率11.0%;COX回归模型多因素分析结果显示,年龄≥60岁、有手术史、ICU入住史、合并感染鲍氏不动杆菌和铜绿假单胞菌是CRE医院感染患者死亡的独立影响因素,使用氨基糖苷类抗菌药物及碳青霉烯类抗菌药物是死亡的独立保护因素(P均<0.05)。结论老年、入住ICU、手术、合并鲍氏不动杆菌及铜绿假单胞菌感染是引起CRE医院感染患者死亡的影响因素,因此要加强多药耐药菌的接触隔离等防控措施,避免多药耐药菌的院内传播,此外碳青霉烯类及氨基糖苷类抗菌药物仍可作为治疗CRE联合用药的选择。

OBJECTIVE To investigate the risk factors associated with prognosis of carbapenem-resistant Enterobacteriaceae（CRE）healthcare-associated infections.METHODS A ambispective dynamic cohort was conducted in two phases from January 2015 from December 2017.The baseline data of patients with CRE healthcare-associated infections from Jan.1,2015 to Dec.31,2017 were retrospectively collected,including age,genders,infection sites,pathogens,underlying diseases,admission to ICU or none,and surgery or none.The antimicrobial usage,other pathogen infections,and survival condition were followed up.The survival time of the patients was determined by the time of diagnosis of CRE healthcare-associated infections to discharge or death.Univariate analysis and multivariable analysis were analyzed by the COX regression model,and the risk factors of prognosis of CRE healthcare-associated infections were screened.RESULTS 499 patients with CRE healthcare-associated infections were evaluated,among them 444 cases were survived,and 55 cases were dead,with the fatality rate of 11.0%.The multivariate analysis by COX regression showed that age≥60 years old,history of surgery admission to ICU,co-infection of Acinetobacter baumannii and Pseudomonas aeruginosa were independent risk factors of death in patients with CRE healthcare-associated infections,and use of aminoglycoside and carbapenems were independent protective factors of death（P〈0.05）.CONCLUSIONCRE infection mortality was higher among older.The elder age,admission to ICU,surgery,and co-infection of A.baumannii and P.aeruginosa are influencing factors of death in patients with CRE healthcare-associated infections.Therefore,we should strengthen the prevention and control measures of contact and isolation of mult-idrug resistant bacteria,to prevent the spread of multi-drug resistant bacteria in hospital.Aminoglycoside and carbapenems can be alternative antibiotics to treat CRE.