碳青霉烯耐药革兰阴性菌血流感染临床分布特征及危险因素分析

Clinical distribution characteristics and risk factors of carbapenem-resistant Gram-negative bacteria bloodstream infection

目的分析我院革兰阴性菌血流感染临床分布特征及碳青霉烯药物耐药的危险因素。方法连续收集我院血流感染患者分离的革兰阴性菌及相应的临床资料,根据是否对碳青霉烯类抗菌药物耐药,分为碳青霉烯耐药革兰阴性菌(CR-GNB)组和碳青霉烯敏感革兰阴性菌(CS-GNB)组,采用logistic回归分析CR-GNB血流感染发生的危险因素。结果139例革兰阴性菌血流感染中26例为碳青霉烯耐药菌,最常见的耐药菌为肺炎克雷伯菌、鲍曼不动杆菌。两组在血流感染发生前住院时长、性别、ICU入住史、PICC置管方面,差异均有统计学意义(Z=-3.56,χ^2分别=4.22、22.08、5.62,P均<0.05),进一步logistic回归显示,ICU入住史、血流感染发生前住院时长是CR-GNB血流感染的危险因素(OR分别=6.87、1.06,P均<0.05)。结论应该加强病原菌耐药性监测,重点把控感染高发科室,严格控制入院及入ICU指征,缩短不必要的住院时间,以减少CR-GNB血流感染的发生。

Objective To analyze the clinical distribution characteristics and risk factors of carbapenem resistance in Gram-negative bacteria bloodstream infections.Methods Gram-negative bacteria isolated from patients with bloodstream infection in our hospital and its related clinical data were collected.The Gram-negative bacteria were divided into two groups:carbapenem resistant Gram-negative bacteria(CR-GNB)group and carbapenem sensitive Gram-negative bacteria(CS-GNB)group.The risk factors of CR-GNB bloodstream infections were analyzed by multivariate logistic regression analysis.Results Of 139 cases with Gram-negative bacteria bloodstream infections,26 strains of carbapene-resistant gram-negative bacteria were screened.The most common carbapene-resistant bacterias were Klebsiella pneumoniae and Acinetobacter baumannii.There were statistical differences in length of hospital stay,gender,history of ICU stay,PICC catheter between the two groups before bloodstream infections(Z=-3.56,χ^2=4.22,22.08,5.62,P<0.05).The logistic regression analysis showed that history of ICU,length of hospital stay were the risk factors of CR-GNB bloodstream infections(OR=6.87,1.06,P<0.05).Conclusion In order to reduce the incidence of CR-GNB bloodstream infection,we should focus on controlling infections in high incidence departments,strictly control admission and ICU indications and shorten the unnecessary hospitalization time.