急诊科耐碳青霉烯类肠杆菌科细菌的耐药现状与感染危险因素分析

Analysis on the status of resistance and risk factors for infection of CRE in the emergency department

目的分析急诊科耐碳青霉烯类肠杆菌科细菌(CRE)的临床分布、耐药情况及感染危险因素。方法回顾性调查北京大学首钢医院急诊科2018年1月至2020年12月期间急诊科住院患者,选取耐碳青霉烯类肠杆菌科细菌感染患者63例作为观察组,同期入院的碳青霉烯类药物敏感肠杆菌科细菌感染患者285例作为对照组,分析观察组患者标本的临床分布、药敏结果,同时采用单因素分析及多因素逻辑回归分析比较两组患者的感染相关因素。结果共检出CRE 63株,其中耐药肺炎克雷伯菌40株(63.50%),耐药大肠埃希菌8株(12.70%),耐药阴沟肠杆菌9株(14.30%),耐药产气肠杆菌6株(9.50%)。CRE对β-内酰胺类抗生素总体耐药率极高,除个别抗生素外可高达100%;对氨基糖苷类、四环素类、喹诺酮类抗生素耐药率在40%~100%之间;耐药肺炎克雷伯菌对粘菌素的耐药率低,为6.30%。年龄≥60岁、住院时间≥14 d、抗菌药物使用时间≥3 d、机械通气时间≥2 d及存在中心静脉置管、气管插管、留置导尿管或胃管均为患者耐碳青霉烯类肠杆菌科细菌感染的独立危险因素(P<0.05)。结论急诊科耐碳青霉烯类肠杆菌科细菌感染由多种因素共同作用引起,耐药情况不容忽视,临床应积极应对,做好感染防控。

Objective To analyze the clinical distribution,resistance and risk factors for infection of carbapenem-resistant Enterobacteriaceae(CRE)in the emergency department.Methods Inpatients admitted to the Emergency Department of Peking University Shougang Hospital from January 2018 to December 2020 were retrospectively investigated.A total of 63 patients with CRE infections were selected as the observation group,and 285 patients with carbapenem-sensitive Enterobacteriaceae infections admitted during the same period were selected as the control group.The clinical distribution of specimens and drug sensitivity of patients in the observation group were analyzed,and the infection-related factors in the two groups were compared by singlefactor analysis and multi-factor logistic regression analysis.Results A total of 63 CRE strains were detected,including 40(63.50%)resistant Klebsiella pneumoniae strians,8(12.70%)resistant Escherichia coli strains,9(14.30%)resistant Enterobacter cloacae strains,and 6(9.50%)resistant Enterobacter aerogenes strains.The overall resistance rate of CRE to β-lactam antibiotics was extremely high,which can up to 100%except for individual antibiotics.The resistance rate of CRE to aminoglycosides,tetracyclines,and quinolones antibiotics was ranged from 40%to 100%.The resistance rate of resistant Klebsiella pneumoniae to colistin was relatively low,which was 6.30%.Age≥60 years,length of stay≥14 d,duration of antimicrobial use≥3 d,duration of mechanical ventilation≥2 d and presence of central venous catheterization,tracheal intubation,indwelling catheter or gastric tube were independent risk factors for CRE infections in patients(P<0.05).Conclusion CRE infections in the emergency department are caused by a combination of various factors,and the resistance situation cannot be ignored.Therefore,the clinical workers should actively respond to it and do a good job in infection prevention and control.