耐碳青霉烯类黏质沙雷菌感染与定植的危险因素

Risk factors for infection and colonization with carbapenemresistant Serratia marcescens

摘要:

目的了解耐碳青霉烯类黏质沙雷菌检出情况，分析耐碳青霉烯类黏质沙雷菌感染与定植的危险因素。方法选取2014年1月—2016年12月某院送检标本中分离出黏质沙雷菌的患者为研究对象。分离出耐碳青霉烯类黏质沙雷菌的患者为病例组，分离出碳青霉烯类敏感黏质沙雷菌的患者为对照组。回顾性调查患者病历资料，对相关因素进行单因素及logistic回归分析。结果共有120例患者分离出黏质沙雷菌。其中病例组患者38例，对照组患者82例。耐碳青霉烯类黏质沙雷菌中32株分离自痰，占84.2%；碳青霉烯类敏感黏质沙雷菌中61株分离自痰，占74.4%。单因素分析显示，患者有低蛋白血症、呼吸衰竭、接受气管插管或切开和血管内置管、两周内碳青霉烯和氟喹诺酮类抗菌药物使用史和ICU入住史是耐碳青霉烯类黏质沙雷菌感染与定植的危险因素（均P＜0.05）。多因素分析结果表明，低蛋白血症和两周内使用过碳青霉烯类抗生素是耐碳青霉烯类黏质沙雷菌感染与定植的独立危险因素（P＜0.05）。结论耐碳青霉烯类黏质沙雷菌的感染和定植与多种因素有关，低蛋白血症和两周内使用过碳青霉烯类抗生素是其独立危险因素。

Abstract:

ObjectiveTo understand isolation of carbapenemresistant Serratia marcescens(CRSM), analyze risk factors for infection and colonization with CRSM.MethodsPatients whose specimens were isolated Serratia marcescens(S. marcescens) in a hospital between January 2014 and December 2016 were recruited in the study. Patients who isolated CRSM were as case group, and those who isolated carbapenemsensitive Serratia marcescens(CSSM) were as control group. Patients’ medical records were surveyed retrospectively, univariate and logistic regression analysis of related factors were performed.ResultsA total of 120 patients were isolated S. marcescens, 38 were in case group, and 82 in control group. 32(84.2%) strains of CRSM and 61(74.4%) strains of CSSM were isolated from sputum respectively. Univariate analysis showed that risk factors for CRSM infection and colonization were patients with hypoproteinemia, respiratory failure, tracheal intubation or tracheotomy, vascular catheterization, history of carbapenem and fluoroquinolone use within two weeks, and history of staying in intensive care unit(all P<0.05). Multivariate analysis showed that hypoproteinemia and carbapenem use within two weeks were independent risk factors for CRSM infection and colonization(P<0.05).ConclusionInfection and colonization with CRSM is related to multiple factors, hypoproteinemia and carbapenem use within two weeks are independent risk factors.