[1]牟雄能,段达荣.碳青霉烯耐药肠杆菌肠道定植及其血流感染的危险因素分析[J].医学信息,2023,36(21):57-60,65.[doi:10.3969/j.issn.1006-1959.2023.21.012]
　MOU Xiong-neng,DUAN Da-rong.Analysis on Colonization of Carbapenems Resistant Enterobacteriaceae and its Risk Factors of Bloodstream Infection[J].Journal of Medical Information,2023,36(21):57-60,65.[doi:10.3969/j.issn.1006-1959.2023.21.012]
点击复制

碳青霉烯耐药肠杆菌肠道定植及其血流感染的危险因素分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年21期
页码:
57-60,65
栏目:
论著
出版日期:
2023-11-01

文章信息/Info

Title:
Analysis on Colonization of Carbapenems Resistant Enterobacteriaceae and its Risk Factors of Bloodstream Infection
文章编号:
1006-1959（2023）21-0057-05
作者:
牟雄能; 段达荣
（台州市第一人民医院急诊科1，检验科2，浙江 台州 318020）
Author(s):
MOU Xiong-neng; DUAN Da-rong
(Department of Emergency1,Department of Clinical Laboratory2,the First People’s Hospital of Taizhou City,Taizhou 318020,Zhejiang,China)
关键词:
碳青霉烯耐药肠杆菌; 肠道定植; 血流感染; 肺炎克雷菌; 糖皮质激素; 中性粒细胞缺乏
Keywords:
Carbapenems resistant enterobacteriaceae; Intestinal colonization; Bloodstream infection; Klebsiella pneumoniae; Glucocorticoids; Neutrophil deficiency
分类号:
R446.5
DOI:
10.3969/j.issn.1006-1959.2023.21.012
文献标志码:
A
摘要:
目的 探讨碳青霉烯耐药肠杆菌科细菌（CRE）定植及引起血流感染的危险因素。方法 选取2016年1月-2022年12月台州市第一人民医院就诊的重点科室住院患者肠道标本及血流感染中检出CRE患者92例，其中血流感染组28例，非血流感染组64例，回顾性分析两组临床资料，并采用多因素Logistic回归分析CRE肠道定植及引起血流感染的危险因素。结果 在92例CRE阳性患者中肠道筛查出64例患者CRE阳性，肺炎克雷菌检出最高为41株（64.06%），其次为产气肠杆菌为8株（12.50%），其它CRE菌株是粘质沙雷菌为6株（9.38%），弗氏枸橼酸杆菌为4株（6.25%），产酸克雷伯菌为3株（4.69%），大肠埃希菌为2株（3.13%）；引起血流感染的28株CRE产碳青霉烯酶中以KPC型最多（64.29%），其它的为OXA型（10.71%）、NDM型（7.14%）、IMP型（7.14%）、VIM型（3.57%）、其它型（7.14%）；Logistic回归分析显示，糖皮质激素使用（OR=4.663,95%CI：0.121~0.903，P=0.031）,中性粒细胞缺乏（OR=8.126，95%CI：0.058~0.590，P=0.004）是CRE引起血流感染的独立危险因素。结论 早期可以CRE筛查及临床干预，降低患者CRE引起血流感染风险，减少高危住院患者CRE感染死亡率。
Abstract:
Objective To explore the colonization of carbapenems resistant enterobacteriaceae (CRE) and the risk factors of bloodstream infection.Methods From January 2016 to December 2022, 92 patients with CRE were selected from the intestinal samples and bloodstream infection of inpatients in key departments of the First People’s Hospital of Taizhou City, Zhejiang Province. Among them, there were 28 patients in the bloodstream infection group and 64 patients in the non-bloodstream infection group. The clinical data of the two groups were analyzed retrospectively, and the risk factors of CRE intestinal colonization and bloodstream infection were analyzed by multivariate Logistic regression.Results Among the 92 CRE-positive patients, 64 patients were CRE-positive by intestinal screening. The detection rate of Klebsiella pneumoniae was the highest (41 strains, 64.06%), followed by Enterobacter aerogenes (8 strains, 12.50%). The other CRE strains were Serratia marcescens (6 strains, 9.38%), Citrobacter freundii (4 strains, 6.25%), Klebsiella oxytoca (3 strains, 4.69%) and Escherichia coli (2 strains, 3.13%). Among the 28 strains of CRE causing bloodstream infection, KPC type was the most (64.29%), followed by OXA type (10.71%), NDM type (7.14%), IMP type (7.14%), VIM type (3.57%) and other types (7.14%). Logistic regression analysis showed that glucocorticoid use (OR=4.663,95%CI:0.121-0.903,P=0.031) and neutropenia (OR=8.126,95%CI:0.058-0.590,P=0.004) were independent risk factors for CRE-induced bloodstream infection.Conclusion Early CRE screening and clinical intervention can reduce the risk of bloodstream infection caused by CRE, and reduce the mortality of CRE infection in high-risk inpatients.

参考文献/References:

[1]胡付品,朱德妹.医疗机构碳青霉烯类耐药肠杆菌细菌感染防控指南简介[J].中国感染与化疗杂志,2018,8(3):331-335.[2]黄先琪,杜芳玲,魏丹丹,等.血流感染肺炎克雷伯菌pLVPK毒力质粒的分布及与耐药的关系[J].中国抗生素杂志,2019,44(6):727-731.[3]胡付品,郭燕,朱德妹,等.2017年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.[4]周庭银,倪语星,王明贵,等.血流感染实验诊断与临床诊治[M].第2版.上海:上海科学技术出版社,2014.[5]中华预防医学会医院感染控制分会,中华医学会感染病学分会,中国医院协会医院感染管理专业委员会,等.中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引[J].中华医院感染学杂志,2019,29(13):2075-2080.[6]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:M100-S30[S].Wayne:CLSI,2020.[7]Cassini A,H?觟gberg LD,Plachouras D,et al.Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis [J].Lancet Infect Dis,2019,19(1):56-66.[8]刘卫平,海云婷,杨丽芳,等.某三级综合医院耐碳青霉烯肠杆菌科细菌流行特征及耐药性分析[J].中华医院感染学杂志,2020,30(19):2943-2948.[9]Escrihuela-Vidal F,Laporte J,Albasanz-Puig A,et al.Update on the management of febrile neutropenia in hematologic patients[J].Rev Esp Quimioter,2019,32(Suppl2):55-58.[10]胡付品,郭燕,朱德妹,等.2018年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2020,20(1):1-10.[11]吴苗苗,杨丹红,潘红英,等.碳青霉烯耐药肠杆菌科细菌定植转血流感染危险因素分析[J].浙江医学,2022,44(12):1300-1303.[12]Hu Y,Ping Y,Li L,et al.A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisitiona-mong ICU patients[J].J Infect Dev Ctries,2016,10(3):208-213.[13]Zhang L,Zhai W,Lin Q,et a1.Carbapenem-resistant Entero-bacteriaceae in hematological patients:outcome of patients with carbapenem-resistant Enterobacteriaceae infection and risk factors for progression to infection after rectal colonization [J].Int J Antimicrob Agents,2019,54(4):527-529.[14]陈云波,嵇金如,应超群,等.2016至2017年全国血流感染细菌耐药监测(BRICS)报告[J].中华临床感染病杂志,2020,13(1):42-54.[15]Chamieh A,El- Hajj G,Zmerli O,et al.Carbapenem resistant organisms: A 9- year surveillance and trends at Saint George University Medical Center[J].J Infect Public Health,2020,13(12):2101-2106.[16]Tomczyk S,Zanichelli V,Grayson ML,et al.Control of Carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in Healthcare Facilities: A Systematic Review and Reanalysis of Quasi-experimental Studies[J].Clin Infect Dis,2019,68(5):873-884.[17]Durante-Mangoni E,Andini R,Zampino R.Management of carbapenem- resistant Enterobacteriaceae infections[J].Clin Microbiol Infect,2019,25(8):943-950.[18]黄细莲,吴盛海,施鹏飞,等.血液科患者肠道碳青霉烯类耐药的肠杆菌科细菌主动筛查及其效果评价[J].中华血液学杂志,2020,41(11):932-936.[19]Palacios-Baena ZR,Giannella M,Manissero D,et al.Risk factors for carbapenem-resistant gram-negative bacterial infections:A systematic review[J].Clin Microbiol Infect,2021,27(2):228-235.[20]Tran D,Larsson M,Olson L,et al.High prevalence of colonisation with carbapenem-resistant enterObacteriaceae among-patients admitted to Vietnamese hospitals:risk factors and burden of disease[J].J Infect,2019,79(2):115-122.[21]徐春晖,宿扬,吕燕霞,等.肛周皮肤拭子细菌培养对血液病患者耐碳青霉烯类肠杆菌血流感染的预警价值[J].中华血液学杂志,2018,39(12):1021-1025.

更新日期/Last Update: 1900-01-01