重症监护病房患者屎肠球菌感染危险因素和耐药性分析

Risk factors and antibiotic resistance of Enterococcus faecium infection in patients in intensive care unit

背景重症监护病房患者的屎肠球菌感染率呈上升趋势,其感染受多因素影响,相关独立危险因素报道较少,同时屎肠球菌的耐药性问题也日益严峻。目的探讨重症监护病房患者屎肠球菌感染的相关危险因素和耐药特性。方法以2021年1-12月解放军总医院第五医学中心重症监护病房66例屎肠球菌感染患者作为病例组,同期60例未感染患者作为对照组,对患者临床资料和分离菌株耐药特性进行分析。结果单因素分析显示:病例组年龄≥60岁,感染前30 d内使用糖皮质激素,使用抗菌药物多于对照组,住院时间长于对照组(P均<0.05);logistic回归分析显示:使用糖皮质激素(OR=2.875,95%CI:1.204~6.867,P=0.017)、使用碳青霉烯类抗菌药物(OR=4.118,95%CI:1.530~11.085,P=0.005)及住院时间≥8 d(OR=5.504,95%CI:1.989~15.232,P=0.001)与重症监护病房患者屎肠球菌感染呈正相关。药敏结果显示:屎肠球菌对万古霉素、四环素、高水平氨基糖苷类耐药率为10.39%~51.95%,对红霉素、克林霉素、喹诺酮类耐药率高达87.01%~97.40%,对青霉素、氨苄西林耐药率达100%。痰标本分离的屎肠球菌对四环素的耐药率低于非痰液标本(30.77%vs 63.16%,P<0.05)。结论感染前30 d内使用糖皮质激素、碳青霉烯类抗菌药物和住院时间≥8 d为重症监护病房患者屎肠球菌感染的独立危险因素,屎肠球菌对临床常用抗菌药物的耐药性差异较大,应根据药敏结果合理选用抗菌药物。

Background The infection rate of Enterococcus faecium in intensive care unit patients is increasing,and its infection is affected by multiple factors,but related independent risk factors are rarely reported.At the same time,the drug resistance of E.faecium is increasingly serious.Objective To investigate the associated risk factors and antibiotic resistance characteristics of E.faecium infection in intensive care unit patients.Methods Totally 66 patients with E.faecium infection were selected as the case group in the intensive care unit of the Fifth Medical Center,Chinese PLA General Hospital from January to December in 2021,while 60 uninfected patients were selected as the control group during the same period to analyze the clinical data about patients and the antibiotic resistance characteristics of the isolated strains.Results Univariate analysis showed that there were significant differences in age≥60 years old,glucocorticoid used,antibiotic used within 30 days before infection,hospital stays between the case group and control group(P<0.05).Logistic regression analysis showed that glucocorticoid used(OR=2.875,95%CI:1.204-6.867,P=0.017),carbapenem antibiotic used(OR=4.118,95%CI:1.530-11.085,P=0.005)within 30 days before infection and hospital stays≥8 days(OR=5.504,95%CI:1.989-15.232,P=0.001)were positively associated with E.faecium infection in the intensive care unit patients.Antimicrobial susceptibility showed that the resistance rates of E.faecium to vancomycin,tetracycline,high-level gentamicin and streptomycin were 10.39%-51.95%,87.01%-97.40%to erythromycin,clindamycin,quinolones,and 100%to penicillin and ampicillin.The resistance rate to tetracycline between E.faecium strains isolated from sputum samples was lower than that in non-sputum samples(30.77%vs 63.16%,P<0.05).Conclusion Glucocorticoid used,carbapenem antibiotic used within 30 days before infection and hospital stays≥8 days are independent risk factors of E.faecium infection in the intensive care unit patients,and the resistance of E.faecium to commonly used antibiotics in clinical varies widely,so antibiotics should be selected rationally according to the results of antimicrobial susceptibility.