某院耐碳青霉烯类肠杆菌感染患者抗菌药物使用分析

Use of antimicrobial drugs in patients with carbapenem-resistant Enterobacteriaceae infection in a hospital

目的分析耐碳青霉烯类肠杆菌科细菌(carbapenem resistant Enterobacteriaceae,CRE)感染的危险因素、抗菌药物的使用情况及预后,为CRE感染患者合理选用抗菌药物提供依据。方法对某院2013-2017年CRE检出菌株及CRE感染患者临床资料进行回顾性研究,探讨CRE感染患者抗菌药物的合理选择。结果104株CRE菌对哌拉西林/他唑巴坦耐药率高达90%以上,对氟喹诺酮类和氨基糖苷类的耐药率<80%;80例CRE感染患者主要分布于ICU、呼吸科、神经外科等科室,死亡或自动出院率为46.25%,其中年龄≥80岁、皮肤黏膜屏障破坏、近期住院史、近期入住ICU、近期使用呼吸机是死亡的高危因素;80例患者中,抗菌药物选择不合理率为66.25%,主要表现为单用抗菌药物不合理。使用不合理的患者死亡率为54.72%,高于使用合理的患者29.63%(χ^2=4.529,P=0.033)。结论CRE耐药率高,感染死亡率高,及时对具有危险因素的CRE感染患者进行预警、合理使用抗菌药物可有效降低死亡率。

OBJECTIVE To analyze the risk factors of carbapenem-resistant Enterobacteriaceae(CRE)infection,the use of antimicrobial drugs and its prognosis,so as to provide evidence for rational use of antimicrobial drugs in CRE-infected patients.METHODS CRE isolates and the clinical data of CRE-infected patients in a hospital from 2013 to 2017 were retrospectively studied to explore the rational use of antibiotics for patients with CRE.RESULTS A total of 104 strains of CRE were collected,and the resistance rate to piperacillin/tazobactam was higher than 90%,and the resistance rate to fluoroquinolones and aminoglycosides was lower than 80%.Among the 80 cases of CRE-infected patients analyzed,most of them were distributed in ICU,respiratory department and neurosurgery,and the rate of death or automatic discharge was 46.25%.Analysis showed that elderly patients aged over 80 years old,destroyed in skin and mucosal barrier,recent admission to ICU,and recent use of ventilators were the potential risk factors of death.Among 80 patients,the rate of irrational use of antimicrobial drugs was 66.25%,dominated by single use.The mortality rate of patients with unreasonable antimicrobial usage was 54.72%,which was significantly higher than that of patients with reasonable usage which was29.63%(χ^2=4.529,P=0.033).CONCLUSION The rate of drug resistance and mortality of CRE are high,and early warning and rational use of antimicrobial drugs can effectively reduce the mortality rate of CRE-infected patients with risk factors.