老年耐碳青霉烯类肠杆菌科细菌感染特点与影响因素分析

Characteristics and risk factors of carbapenem-resistant Eenterobacteriaceae infection in elderly patients

目的研究老年患者感染耐碳青霉烯类肠杆菌科细菌的临床特点、耐药情况及临床愈后,并分析其感染的影响因素,为临床进行有效地预防和治疗提供参考。方法收集2014年1月-2018年6月老年住院感染患者的资料,耐碳青霉烯类肠杆菌科细菌(CRE)感染组75例,无CRE感染病例150例设为无CRE感染组。分析患者年龄、性别、基础疾病情况、治疗操作及用药情况等临床资料,归纳老年患者CRE感染的影响因素。结果 CRE组的科室分布以呼吸内科病区,神经科重症病区和老年病病区为主;呼吸道感染是主要的感染部位;感染病原菌以肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌为主。CRE组老年患者的死亡占20.00%(15/75)高于未感染CRE组(P<0.05)。气道插管、使用碳青霉烯类药物、连续一周使用抗菌药物是老年患者CRE感染的影响因素(P<0.05)。结论老年患者是CRE的易感人群,愈后差,呼吸道是主要的感染部位。临床应对影响因素及早预防,合理使用抗菌药物以降低感染率。

OBJECTIVE To study the clinical characteristics,drug resistance and clinical convalescence of carbapenem-resistant Enterobacteriaceae in elderly patients,and to analyze the influencing factors of infection,so as to provide reference for clinical prevention and treatment.METHODS The data of elderly hospitalized patients with infection from Jan.2014 to Jun.2018 were collected.There were 75 cases of infection with carbapenem-resistant Enterobacteriaceae(CRE),which were set as the infected group,and 150 cases without CRE infection were included in the control group.The patients’clinical data such as age,gender,underlying disease,treatment and medication were analyzed to summarize the risk factors of CRE infection in elderly patients.RESULTS The top three departments of the CRE group were the respiratory medicine department,the neurology ICU department,and the geriatric department.Respiratory tract was the main site of infection.The pathogens were mainly Klebsiella pneumoniae,Escherichia coli and Enterobacter cloacae.The mortality rate of elderly patients in the CRE group was 20%(15/75),significantly higher than that in the uninfected CRE group(P<0.05).Endotracheal intubation,use of carbapenem and continuous use of antimicrobial drugs for more than one week were independent risk factors for CRE infection in elderly patients.CONCLUSION Elderly patients are susceptible to CRE,and the prognosis is poor,with respiratory tract as the main site of infection.Clinicians should prevent risk factors early and use antibiotics rationally to reduce the infection rate.