摘要
目的分析昆明医科大学第一附属医院住院的耐碳青霉烯类肠杆菌目细菌(CRE)定植与感染者临床特征、耐药情况和危险因素,为预防CRE感染提供依据。方法收集昆明医科大学第一附属医院2021年1—11月主动筛查CRE定植阳性患者的临床资料和耐药状况,对同种CRE定植和感染患者菌株进行多位点序列分型(MLST),其中CRE肠道外感染者作为病例组,未发生CRE肠道外感染者作为对照组,并通过单因素分析对比两组之间差别,多因素Logistic分析对CRE感染者所引起的独立危险因素。结果3116例中主动筛查CRE定植阳性的患者检出CRE 73株,检测阳性率为2.34%,其中耐碳青霉烯肺炎克雷伯菌63株(86.30%)、耐碳青霉烯大肠埃希菌8株(10.96%)、耐碳青霉烯阴沟肠杆菌2株(2.74%)。尚未出现对多黏菌素和替加环素耐药的菌株,对阿米卡星、复方磺胺甲噁唑、庆大霉素等部分敏感,对其他抗菌药物的耐药率为100.0%。病例组31株发生定植后的CRE感染,感染部位以下呼吸道感染为主,其次为血液、尿路。对病例组CRE定植后发生感染耐碳青霉烯肺炎克雷伯菌30株配对MLST检测,为ST11(23/30)和ST231(7/30)两种型。通过多因素Logistic分析发现,中心静脉置管、使用质子泵抑制剂、有多重耐药菌感染史是CRE感染的独立危险因素(P<0.05)。结论主动筛查在CRE防控中具有重要意义,中心静脉置管、使用质子泵抑制剂、有多重耐药菌感染史是CRE感染的独立危险因素,应加强对易感患者的监控。
Objective To analyze the clinical characteristics,drug resistance and risk factors of patients with colonization and infection of Carbapenem-resistant Enterobacteriaceae(CRE)in the First Affiliated Hospital of Kunming Medical University,and to provide theoretical basis for the prevention of CRE infection.Methods The clinical data and drug resistance status of patients with positive CRE colonization actively screened in the First Affiliated Hospital of Kunming Medical University from January to November 2021 were collected,and multilocus sequence typing(MLST)was performed for the strains of patients with the same CRE colonization and infection.The patients with parenteral infection of CRE were taken as the case group and the patients without CRE infection as the control group.The differences between the two groups were compared by univariate analysis,and the independent risk factors caused by CRE infection were analyzed by multivariate Logistic analysis.Results 73 strains of CRE were detected in 3116 patients with positive CRE colonization,and the positive rate was 2.34%.Among them,63 strains of Carbapenem-resistant Klebsiella pneumoniae accounted for 86.30%,8 strains of Carbapenem-resistant Escherichia coli accounted for 10.96%,and 2 strains of Carbapenem-resistant Enterobacter cloacae accounted for 2.74%.Strains resistant to polymyxin and tegacycline had not yet appeared,and were partially sensitive to amikacin,sulfamethoxazole and gentamicin,and the resistance rate to other antimicrobial agents was 100.0%.31 cases developed CRE infection after colonization,and the main infection site was respiratory tract infection,followed by blood and urinary tract infection.Paired MLST detection of 30 strains of Carbapenem-resistant Klebsiella pneumoniae infections occurred in case group after CRE colonization with both ST11(23/30)and ST231(7/30).Through multivariate Logistic analysis,it was found that central venous catheterization,long-term use of proton pump inhibitors and infection history of multiple drug-resistant bacteria were independent risk factors for CRE infection(P<0.05).Conclusion Active screening plays an important role in the prevention and control of CRE.Central venous catheterization,long-term use of proton pump inhibitors and infection history of multiple drug-resistant bacteria are independent risk factors of CRE infection.Monitoring of susceptible patients should be strengthened.
作者
马志刚
孟雪斐
张鸿娟
单斌
MA Zhigang;MENG Xuefei;ZHANG Hongjuan;SHAN Bin(Department of Clinical Laboratory,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China;Yunnan Provincial Clinical Research Center for Laboratory Medicine,Kunming,Yunnan 650032,China;Yunnan Provincial Key Laboratory of Laboratory Medicine,Kunming,Yunnan 650032,China;Zhaotong Hospital of Traditional Chinese Medicine,Zhaotong,Yunnan 657000,China)
出处
《检验医学与临床》
CAS
2022年第21期2894-2899,共6页
Laboratory Medicine and Clinic
基金
科技部科技基础资源调查专项项目(2019FY101200、2019FY101209)。
关键词
耐碳青霉烯类肠杆菌目细菌
定植
感染
临床特征
Carbapenem-resistant Enterobacteriaceae
colonization
infection
clinical features
