耐碳青霉烯类肠杆菌科细菌临床分布特点及危险因素分析

Analysis of clinical characteristics and risk factors in Carbapenem-resistant Enterobacteriaceae infection

目的分析我院耐碳青霉烯类肠杆菌科细菌(Carbapenem-resistant Enterobacteriaceae,CRE)临床分布特点和危险因素。方法回顾性分析哈尔滨医科大学附属第二医院2017年1月~2019年12月期间293例CRE感染患者的临床资料,以同期293例碳青霉烯类敏感的肠杆菌科细菌(Carbapenem-sensitive Enterobacteriaceae,CSE)感染患者作为对照组,采用单因素分析比较两组间差异,Logistic多因素分析CRE感染发生的独立危险因素。结果CRE检出率为2.08%(293/14086),主要检出菌株为肺炎克雷伯菌46.08%(135/293),其次是大肠埃希菌19.80%(58/293)、阴沟肠杆菌13.65%(40/293);呼吸道标本中CRE检出率最高41.64%(122/293),其次是泌尿道、各种穿刺液和外周血,分别为19.80%(58/293)、18.77%(55/293)和14.68%(43/293);主要检出科室是ICU占20.14%(59/293),其次是泌外科、普外科均为11.60%(34/293),神经外科为11.26%(33/293);多因素Logistic分析发现,胸腔穿刺(OR=2.956,95%CI:1.295~6.745,P=0.010)和之前使用过替加环素(OR=2.246,95%CI:1.071~4.712,P=0.032)为CRE感染的独立危险因素。结论我院CRE感染主要菌株是肺炎克雷伯菌和大肠埃希菌;胸腔穿刺和之前使用过替加环素是我院CRE感染的独立危险因素。

Objective To analyze the clinical characteristics and risk factors of Carbapenem-resistant Enterobacteriaceae(CRE)infection in our hospital,so as to provide a strong basis for preventing and controling CRE infection.Methods The histories of 293 non repetitive patients with CRE infection from January 2017 to December 2019 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed,and 293 cases of Carbapenem-sensitive Enterobacteriaceae(CSE)infection in the same period were selected as the control group.The differences between the two groups were compared by univariate analysis,and the independent risk factors of CRE infection were analyzed by logistic multivariate analysis.Results The overall CRE infection incidence was 2.08%(293/14086).The CRE isolates mainly were Klebsiella pneumoniae 46.08%(135/293),followed by Escherichia coli 19.80%(58/293)and Enterobacter cloacae 13.65%(40/293);CRE were mainly isolated from respiratory tract 41.64%(122/293),followed by urinary tracts,sterile body fluids of various parts and peripheral blood culture which were 19.80%(58/293),18.77%(55/293)and 14.68%(43/293),respectively;the isolation rate of CRE in the department of ICU was 20.14%(59/293),department of urology and general surgery was each 11.60%(34/293),and department of neurosurgery was 11.26%(33/293);Multivariate analysis showed that thoracentesis(OR=2.956,95%CI:1.295~6.745,P=0.010)and previous use of tigecycline(OR=2.246,95%CI:1.071~4.712,P=0.032)were independent risk factors for CRE infection.Conclusion CRE isolates mainly are Klebsiella pneumoniae and Escherichia coli;thoracentesis and previous use of tigecycline therapy are independent risk factors of CRE infection in our hospital.