碳青霉烯类耐药肠杆菌科细菌感染分布、耐药性监测及预后危险因素分析

Bacterial distribution,drug resistance monitoring and prognostic risk factor analysis for carbapenem-resistant Enterobacteriaceae infection

目的 探讨碳青霉烯类耐药肠杆菌科细菌(CRE)感染分布特征及耐药性,分析影响感染患者预后的危险因素。方法 回顾性分析2020年6月至2023年7月德清县中医院收治的97例CRE感染患者的临床资料,统计并分析患者体液及分泌物标本中的病原菌分布及耐药特点。根据患者预后分为存活组(41例)和死亡组(56例),采用多因素Logistic回归分析影响患者预后的独立危险因素。结果 106株CRE中主要病原菌为肺炎克雷伯菌(47株,44.34%)和大肠埃希菌(31株,29.25%),主要来源于痰液标本(51株,48.11%)和尿液标本(28株,26.42%)。肺炎克雷伯菌对亚胺培南、美罗培南、帕尼培南等抗生素的耐药率均>70%;大肠埃希菌对美罗培南、帕尼培南、厄他培南等抗生素的耐药率均>70%,对替加环素不具耐药性。留置静脉导管[OR(95%CI):1.830(1.213~2.756),P=0.004]、ICU治疗[OR(95%CI):1.793(1.135~2.492),P=0.003]、感染性休克[OR(95%CI):2.140(1.498~3.430),P<0.001]为CRE感染患者死亡的独立危险因素。结论 肺炎克雷伯菌和大肠埃希菌是CRE感染的主要病原菌,具有较强的耐药性,留置静脉导管、ICU治疗和感染性休克为患者死亡的独立危险因素。

Objective To explore the distribution characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae(CRE)infection and analyze the risk factors affecting the prognosis of infected patients.Methods A retrospective analysis was conducted on the clinical data of 97 patients with CRE infection admitted to Deqing County Hospital of Traditional Chinese Medicine from June 2020 to July 2023.The distribution and drug resistance characteristics of pathogenic bacteria in patient body fluids and secretions were statistically analyzed.Patients were divided into a survival group(n=41)and a death group(n=56)based on their prognosis,and multivariate logistic regression analysis was used to identify independent risk factors affecting patient prognosis.Results A total of 106 strains of CRE were isolated,with the main pathogenic bacteria being Klebsiella pneumoniae(44.34%(47/106))and Escherichia coli(29.25%(31/106)),primarily derived from sputum(48.11%(51/106))and urine samples(26.42%(28/106)).The resistant rate of Klebsiella pneumoniae to antibiotics such as imipenem,meropenem,and panipenem was more than 70%and that of Escherichia coli to antibiotics such as meropenem,panipenem,and ertapenem was also over 70%.However,the latter one was not resistant to tigecycline.Indwelling intravenous catheters(OR(95%CI):1.830(1.213-2.756),P=0.004),ICU treatment(OR(95%CI):1.793(1.135-2.492),P=0.003),and septic shock(OR(95%CI):2.140(1.498-3.430),P<0.001)were identified as independent risk factors for death in patients with CRE infection.Conclusion Klebsiella pneumoniae and Escherichia coli are the main pathogenic bacteria causing CRE infection and exhibit strong drug resistance.Indwelling intravenous catheters,ICU treatment and septic shock are independent risk factors for patient death.