医院获得性耐碳青霉烯类肠杆菌科下呼吸道感染临床特征及危险因素分析

Analysis of Clinical Characteristics and Risk Factors of Lower Respiratory Tract Infection with Hospital Acquired Carbapenem-resistant Enterobacteriaceae

目的研究耐碳青霉烯类肠杆菌科细菌(CRE)的分布和耐药特征,以及CRE下呼吸道道感染的危险因素,为有效控制CRE院内感染和合理用药提供依据。方法分析2012年4月至2019年6月CRE菌株信息和下呼吸道感染患者的临床资料,选择同时期同病区下呼吸道感染碳青霉烯类敏感肠杆菌科细菌(CSE)患者作为对照组进行危险因素分析。结果CRE菌株主要以肺炎克雷伯菌为主,对临床常用抗生素耐药性高,对氨基糖苷类、多粘菌素B、替加环素、米诺环素敏感性高,对碳青霉烯类抗生素呈高度耐药性。我院CRE下呼吸道感染的单因素分析显示危险因素为留置尿管、鼻胃管、机械通气、手术、感染前入住ICU>48小时、感染前住院时间长、使用激素、糖肽类抗生素、碳青霉烯类抗生素、抗真菌药物、合并呼吸衰竭;多因素分析显示CRE下呼吸道感染的独立危险因素是碳青霉烯类抗生素的使用(OR=2.882;95%CI 1.017-8.166)。结论合理使用抗生素,限制碳青霉烯类抗生素的使用,规范临床操作是降低CRE下呼吸道感染的关键。

Objective To study the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE) and the risk factors of CRE lower respiratory tract infection,and provide evidence for effective control of CRE hospital infection and rational drug use.Methods The information of CRE strain and the clinical data of patients with lower respiratory tract infection from April 2012 to June 2019 in our hospital were analyzed.The patients with Carbapenem sensitive Enterobacteriaceae(CSE)in the same period were selected as the control group for risk factors analysis.Results The CRE strain is mainly Klebsiella pneumoniae,which is high resistance to common clinical antibiotics,high sensitivity to aminoglycosides,polymyxin B,tigecycline and minocycline,carbapenem.And which is highly resistant to carbapenem antibiotics.Univariate analysis of CRE lower respiratory tract infection in our hospital showed that the risk factors were indwelling catheter,nasogastric tube,mechanical ventilation,operation,staying in ICU for more than 48 hours before infection,long hospitalization time before infection,using hormone,glycopeptide antibiotics,carbapenem antibiotics,antifungal drugs and respiratory failure.Multivariate analysis showed that the independent risk factor for lower respiratory tract infection in CRE was the use of carbapenems(OR=2.882;95%CI 1.017-8.166).Conclusion Rational use of antibiotics,limiting the use of carbapenems,and standardizing clinical procedures are key to reducing respiratory infections in CRE.