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目的研究耐碳青霉烯类肠杆菌科细菌(CRE)的感染特征、临床预后及危险因素,以提高临床对CRE感染的认识和控制干预,帮助临床用药治疗。方法采用1∶1∶1的病例-病例-对照研究方法,收集医院2013年1月-2015年6月耐碳青霉烯类肠杆菌科细菌感染患者(CRE组),碳青霉烯类抗菌药物敏感(CSE)感染患者(CSE组)和未感染大肠埃希菌或肺炎克雷伯菌的对照组,各64例,共计192个病例;回顾性分析患者的临床资料,预测耐碳青霉烯类肠杆菌科细菌感染的危险因素。结果呼吸道感染是CRE医院感染的最常见来源,占42.19%,患者的住院科室主要分布在儿科(31.25%)和危重症监护室(26.56%);通过CRE与对照组的多因素模型分析,只有气管插管和感染前抗菌药物使用是CRE感染的独立危险因素;通过CSE与对照组单因素比对分析,只有感染前抗菌药物使用是CSE感染的危险因素;气管插管和感染前抗菌药物使用是CRE感染的独立危险因素,也是CRE感染区别于CSE感染的危险因素;64例CRE患者中12例死亡,病死率为18.75%。结论新生儿、儿童和重症患者是CRE感染的易感人群;CRE最常见感染部位为呼吸道;感染前抗菌药物使用与气管插管和CRE感染相关,是CRE感染区别于CSE感染的特有危险因素。
Objective To study the infection characteristics, clinical prognosis and risk factors of carbapenem-resistant enterobacteriaceae (CRE) in order to improve clinical understanding and control intervention on CRE infection and to help clinical drug treatment. Methods A case-control study was conducted in a 1: 1: 1 case-control study. Patients in the hospital from January 2013 to June 2015 were enrolled in this study. Patients with carbapenem-resistant enterobacteriaceae (CRE), carbapenem- Sixty-four patients in CSE group (CSE group) and control group without E.coli or Klebsiella pneumoniae were enrolled. A total of 192 cases were included. The clinical data of patients were retrospectively analyzed, Enterobacteriaceae bacterial infection risk factors. Results Respiratory infections were the most common source of CRE hospital infection, accounting for 42.19%. The hospitalization departments of patients were mainly pediatric (31.25%) and critically ill intensive care unit (26.56%). By multivariate analysis of CRE and control group, Tracheal intubation and infection before use of antimicrobial agents is an independent risk factor for CRE infection; CSE and control by single factor analysis, only the use of antimicrobial agents before infection is a risk factor for CSE infection; tracheal intubation and infection before use of antimicrobial agents Is an independent risk factor for CRE infection and is also a risk factor for the difference of CRE infection from CSE infection. Twelve of 64 CRE patients died with a mortality rate of 18.75%. CONCLUSIONS: Newborns, children and critically ill patients are susceptible to CRE infection. The most common site of CRE infection is the respiratory tract. Pre-infection use of antibacterials is associated with tracheal intubation and CRE infection, which is a unique risk factor for CRE infection from CSE infection.