神经外科耐碳青霉烯类肠杆菌医院感染耐药特征及危险因素

Drug resistance characteristics of carbapenem-resistant Enterobacteriaceae causing nosocomial infection in neurosurgery department patients and risk factors

目的探讨神经外科耐碳青霉烯类肠杆菌(CRE)医院感染耐药特征及危险因素。方法选择2018年12月-2021年12月在湖南省常德市第一人民医院神经外科住院期间并发肠杆菌科医院感染的97例患者为研究对象,根据是否存在CRE感染,分为CRE组52例和非CRE组45例。采用全自动微生物系统鉴定病原菌种并分析其耐药特征;统计患者入院时格拉斯哥评分(GCS)、急性生理与慢性健康评分II(APACHE II)、既往CRE感染史、留置尿管等临床资料。结果97例患者中检出CRE菌株共52株,占比53.61%;CRE组抗菌药物耐药率高于非CRE组(P<0.05);两组左氧氟沙星、头孢曲松和替加环素耐药率比较,无统计学差异;单因素分析结果显示,神经外科住院患者发生CRE感染与性别、年龄、入院时GCS评分、APACHE II评分、手术时间、肠内营养、首次白蛋白和低温治疗无关;比较两组既往CRE感染史、留置尿管等临床资料差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,既往CRE感染史、留置尿管等因素均是导致发生CRE感染的影响因素(P<0.05)。结论CRE在神经外科住院病房流行形势严峻,分析既往CRE感染耐药特征及危险因素有助于降低其发病率,改善患者预后。

OBJECTIVE To explore the drug resistance characteristics of carbapenem-resistant Enterobacteriaceae(CRE)causing nosocomial infection in neurosurgery department patients and analyze the risk factors.METHODS A total of 97 patients who were hospitalized in neurosurgery department of the First People’s Hospital of Changde City,Hunan Province and were complicated with Enterobacteriaceae nosocomial infection were recruited as the study objects and divided into the CRE group with 52 cases and the non-CRE group with 45 cases according to the status of CRE infection.The species of pathogens were identified by automatic microorganisms system,the characteristics of drug resistance were analyzed.The clinical data such as Glasgow score(GCS),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,previous history of CRE infection and urinary catheter indwelling at the admission to hospital were statistically analyzed.RESULTS Totally 52 strains of CRE were isolated from the 97 patients,accounting for 53.16%.The drug resistance rate of the CRE group was higher than that of the no-CRE group(P<0.05);there were no significant differences in the drug resistance rates to levofloxacin,ceftriaxone and tigecycline between the two groups.The result of univariate analysis showed that the incidence of CRE infection in the hospitalized patients of neurosurgery department was not associated with gender,age,GCS score at the admission to hospital,APACHE II score,operation duration,enteral nutrition,initial albumin or hypothermia treatment;there were significant differences in the previous history of CRE infection and urinary catheter indwelling between the two groups(P<0.05).Multivariate logistic regression analysis indicated that the previous history of CRE infection and urinary catheter indwelling were the influencing factors for the CRE infection(P<0.05).CONCLUSION CRE is prevalent in the wards of neurosurgery department.The analysis of drug resistance characteristics and risk factors for CRE infection may facilitate the reduction of the incidence and improvement of prognosis.