| 摘要: |
| 目的 研究耐碳青霉烯类肠杆菌科细菌(CRE)的分布和耐药特征,以及CRE下呼吸道道感染的危险因素,为有效控制CRE院内感染和合理用药提供依据。方法 分析2012年4月-2019年6月CRE菌株信息和下呼吸道感染患者的临床资料,选择同时期同病区下呼吸道感染碳青霉烯类敏感肠杆菌科细菌(CSE)患者作为对照组进行危险因素分析。结果 CRE菌株主要以肺炎克雷伯菌为主,对临床常用抗生素耐药性高,对氨基糖苷类、多粘菌素B、替加环素、米诺环素敏感性高,对碳青霉烯类抗生素呈高度耐药性。我院CRE下呼吸道感染的单因素分析显示危险因素为留置尿管、鼻胃管、机械通气、手术、感染前入住ICU>48小时、使用激素、糖肽类抗生素、碳青霉烯类抗生素、抗真菌药物、合并呼吸衰竭；多因素分析显示CRE下呼吸道感染的独立危险因素是碳青霉烯类抗生素的使用(OR=2.882;95%CI 1.017-8.166)。结论 合理使用抗生素,限制碳青霉烯类抗生素的使用,规范临床操作是降低CRE下呼吸道感染的关键。 |
| 关键词: 耐碳青霉烯类肠杆菌科细菌 耐药性 危险因素 下呼吸道感染 |
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| Clinical characteristics and risk factors of lower respiratory tract infection in hospital-acquired carbapenem-resistant Enterobacteriaceae |
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| Abstract: |
| Objective To study the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae (CRE) and the risk factors of respiratory tract infection under CRE, and provide evidence for effective control of CRE hospital infection and rational drug use. Methods The clinical data of CRE strains and patients with lower respiratory tract infections from April 2012 to June 2019 were analyzed. The patients with lower intestinal tract infections of carbapenem-sensitive Enterobacteriaceae (CSE) in the same period were selected as the control group. Analysis of risk factors. Results The CRE strain was mainly Klebsiella pneumoniae, and it was highly resistant to common clinical antibiotics. It was highly sensitive to aminoglycosides, polymyxin B, tigecycline and minocycline. The olefinic antibiotic is highly resistant. Univariate analysis of respiratory infections in CRE in our hospital showed that the risk factors were indwelling catheter, nasogastric tube, mechanical ventilation, surgery, ICU>48 hours before infection, hormone, glycopeptide antibiotics, carbapenem antibiotics, Antifungal drugs, combined with respiratory failure; multivariate analysis showed that the independent risk factor for CRE lower respiratory tract infection was the use of carbapenems (OR = 2.882; 95% CI 1.017-8.166). Conclusion Rational use of antibiotics, limiting the use of carbapenems, and standardizing clinical procedures are key to reducing respiratory infections in CRE. |
| Key words: carbapenem-resistant Enterobacteriaceae bacteria drug resistance risk factors lower respiratory tract infection |