239例碳青霉烯耐药肠杆菌科细菌血流感染病例的临床分析

Clinical analysis of 239 cases of bloodstream infections caused by carbapenem-resistant enterobacteriaceae bacteria

目的分析该院2015—2019年发生碳青霉烯耐药肠杆菌科细菌(CRE)血流感染患者的临床资料以及治疗、预后情况,探讨CRE血流感染的发生特点以及影响患者预后的因素。方法收集该院2015年1月1日至2019年12月31日收治的239例住院期间发生CRE血流感染患者的病历资料,以发生CRE血流感染后30 d作为观察终点,分为存活组和死亡组,比较两组患者的临床特点及治疗上的差异。根据治疗药物种类不同,采用单药治疗的患者纳入单药治疗组,采用两种或两种以上敏感药物联合治疗的患者纳入联合治疗组。以Kaplan-Meier(K-M)法绘制生存曲线,比较单药治疗组和联合治疗组之间生存率的差异。采用COX比例风险回归模型评估与死亡相关的独立危险因素。结果死亡组、存活组在住院天数、此次入院前3个月是否有住院史、是否存在中性粒细胞缺乏、Pitt菌血症评分、血流感染后72 h内是否发生感染性休克、发生血流感染前是否有手术操作、单药还是联合治疗方面的差异均有统计学意义(P<0.05)。单药治疗组和联合治疗组的累积生存率比较,差异有统计学意义(P=0.005)。重症监护室(ICU)治疗、血流感染后72 h内休克、中性粒细胞缺乏为死亡的相关独立危险因素(P<0.05),住院天数长、联合治疗为保护因素(P<0.05)。结论ICU治疗、血流感染后72 h内休克、中性粒细胞缺乏为死亡的相关独立危险因素。联合治疗有利于降低患者的病死率,改善预后。

Objective To analyze the clinical data,treatment and prognosis situation in the patients with bloodstream infection caused by carbapenem-resistant enterobacteriaceae(CRE)bacteria in this hospital during 2015-2019,and to investigate the occurrence characteristics of CRE bloodstream infections and the factors affecting the patients prognosis.Methods The medical data of 239 inpatients with CRE bloodstream infection in this hospital from January 1,2015 to December 31,2019 were collected.With 30 d after CRE bloodstream infection occurrence as the observation end point,the patients were divided into the survival and death groups.The differences in clinical characteristics and treatment were compared between the two groups.According to the different treatment drugs,the cases adopting the single drug treatment were included into the single medication group,while the cases adopting the two or more sensitive drugs were included into the combined medication group.The survival curve was drawn by the Kaplan-Meier(K-M)method.The difference in the survival rate was compared between the single medication group and combined medication group.The independent risk factors related with death were evaluated by adopting the COX proportional hazard regression model.Results There were statistically significant differences in the number of hospitalization days,hospitalization history in 3 months before admission,agranulocytosis,Pitt bacteremia score,septic shock within 72 h after bloodstream infection occurrence,surgical operation before bloodstream infection occurrence,single medication or combined medication between the death group and and survival group(P<0.05).The cumulative survival rate had statistical difference between the single medication group and combined medication group(P=0.005).The ICU treatment,shock within 72 h of bloodstream infection and agranulocytosis were the death related independent risk factors(P<0.05).The number of hospitalization days and the combined medication were the protective factors(P<0.05).Conclusion The ICU treatment,shock within 72 h of bloodstream infection and agranulocytosis are the death related independent risk factor.The combined medication is conducive to reduce the death rate of the patients and improves the prognosis.