医院获得性耐碳青霉烯类肠杆菌目细菌血流感染危险因素

Risk factors for healthcare-associated bloodstream infection of carbape-nem-resistant Enterobacterales

摘要:

目的 分析医院获得性耐碳青霉烯类肠杆菌目细菌(CRE)血流感染的特点及影响因素。 方法 采用回顾性巢式病例对照研究方法, 选取2020年1月—2022年12月某三级综合医院发生医院获得性CRE血流感染的56例病例为CRE组, 按1 ∶1选择同期56例碳青霉烯类敏感肠菌目细菌(CSE)血流感染患者为CSE组, 分析感染菌株和科室分布, 并通过单因素和多因素logistic回归分析CRE血流感染的相关因素。 结果 CRE血流感染科室分布以重症监护病房(ICU, 23例, 41.07%)) 和血液科(17例, 30.36%)为主; 感染菌株主要为肺炎克雷伯菌(32例, 57.14%)和大肠埃希菌(16例, 28.57%)。单因素分析结果显示, 恶性肿瘤、60 d内住院史、感染前入住ICU＞48 h、机械通气、留置中央静脉导管、使用二联及以上抗菌药物、抗菌药物使用时间≥10 d均与CRE血流感染有关(均P＜0.05)。多因素logistic回归分析发现, 感染前入住ICU＞48 h、感染前抗菌药物使用时间≥10 d是医院获得性CRE血流感染的独立危险因素(P＜0.05)。 结论 临床尤其是ICU应关注患者的流行病学史, 尽早识别CRE血流感染高危因素的患者, 同时合理使用抗菌药物, 规范有创操作, 以减少医院获得性CRE血流感染的发生。

Abstract:

Objective To analyze the characteristics and influencing factors of healthcare-associated bloodstream infection (HA-BSI) of carbapenem-resistant Enterobacterales (CRE). Methods Retrospective nested case-control study was adopted. Fifty-six patients with CRE HA-BSI in a tertiary general hospital from January 2020 to December 2022 were selected as the CRE group. With a 1:1 ratio, 56 patients with carbapenem-sensitive Enterobacterales (CSE) BSI during the same period was selected as the CSE group. Distribution of infection strains and departments was analyzed, and the relevant factors for CRE BSI were analyzed by univariate and multivariate logistic regression analyses. Results The distribution of CRE BSI was mainly in intensive care unit (ICU, n=23, 41.07%) and department of hematology (n=17, 30.36%). The main infection strains were Klebsiella pneumoniae (n=32, 57.14%) and Escherichia coli (n=16, 28.57%). Univariate analysis showed that malignant tumor, hospitalization history within 60 days, stay in ICU for >48 hours before infection, mechanical ventilation, indwelling central venous cathe-ter, combined use of at least two kinds of antimicrobial agents, and duration of antimicrobial use ≥10 days were all related to CRE BSI (all P < 0.05). Multivariate logistic regression analysis found that stay in ICU>48 hours before infection and duration of antimicrobial use ≥10 days before infection were independent risk factors for CRE HA-BSI (P < 0.05). Conclusion Clinical departments, especially ICU, should pay attention to the epidemiological history of patients, identify patients with high-risk factors for CRE BSI as early as possible, use antimicrobial agents ratio-nally and standardize invasive procedure, so as to reduce the occurrence of CRE HA-BSI.