造血干细胞移植患者耐碳青霉烯肠杆科细菌血流感染的影响因素分析

An analysis of influencing factors for carbapenem-resistant Enterobacteriaceae infectionin in patients undergoing hematopoietic stem-cell transplantation

目的 探讨造血干细胞移植(HSCT)患者发生耐碳青霉烯肠杆科细菌(CRE)血流感染的影响因素。方法 行HSCT的992例血液肿瘤患者,根据是否发生CRE血流感染分为感染组(17例)与非感染组(975例)。比较两组患者的人口学资料及临床资料。采用多因素logistic回归模型分析HSCT患者发生CRE血流感染的危险因素。结果 992例HSCT患者中,17例发生CRE血流感染,发生率为1.71%。感染组男性比例、合并肺部感染和肾功能不全比例、使用碳青霉烯类抗生素、3/4代头孢类抗生素、大环内酯类抗生素、替加环素、达托霉素比例均高于非感染组(P<0.05)。多因素logistic回归分析结果显示,男性、合并肺部感染和肾功能不全、使用大环内酯类抗生素和替加环素是HSCT患者发生CRE血流感染的独立危险因素(P<0.05)。结论 合并肺部感染和肾功能不全的患者以及血流感染前使用大环内酯类抗生素和替加环素的HSCT患者更易发生CRE血流感染。

Objective To investigate the risk factors for carbapenem-resistant Eenterobacteriaceae(CRE) bloodstream infection in the patients underwent hematopoietic stem-cell transplantation(HSCT).Methods A total of 992 blood tumor patients underwent HSCT were divided into two groups of A(with CRE bloodstream infection, 17 cases) and B(without CRE bloodstream infection, 975 cases).The demographic and clinical data of two groups were compared.The multivariate logistic regression model was used to analyze the risk factors for CRE bloodstream infection in the patients underwent HSCT.Results Among 992 patients underwent HSCT,CRE bloodstream infection occurred in 17 patients with the incidence rate of 1.71%.The percentages of males and the patients with concurrent pulmonary infections and renal insufficiency, and the use of carbapenem antibiotics, 3/4 generation cephalosporins, macrolides, tigecycline, and daptomycin in group A were higher than those in group B(P<0.05).The results of multivariate logistic regression analysis showed that male, concurrent pulmonary infection and renal dysfunction, use of macrolide antibiotics and tigecycline were the independent risk factors for CRE bloodstream infection in the patients underwent HSCT(P<0.05).Conclusion CRE bloodstream infection is more likely to occur in HSCT patients with pulmonary infection and renal insufficiency and those used macrolide antibiotics and tigecycline before bloodstream infection.