目的 探讨医院获得性感染耐碳青霉烯类肠杆菌科细菌(CRE)的耐药性及感染者的临床结局。方法 选择2017-01至2023-06在武警四川总队医院住院的成年CRE感染患者341例作为病例组,336例碳青霉烯类敏感肠杆菌科细菌(CSE)感染患者作为敏感组,354例非肠杆菌科细菌感染的同时期住院患者作为对照组。使用药敏板条、肉汤稀释法检测临床常用抗菌药物对CRE的最低抑菌浓度,另外采用单变量和多变量分析医院获得性感染CRE患者的临床结局。结果 分离CRE最常见的标本类型依次是痰液、尿液和血液,CRE中占比前三依次为耐碳青霉烯类肺炎克雷伯菌(CR-Kpn)、耐碳青霉烯类大肠埃希菌(CR-Eco)、耐碳青霉烯类阴沟肠杆菌(CR-Ecl)。替加环素和黏菌素为CR-Kpn和CR-Eco体外敏感率最高的前两位药物,四环素对CR-Kpn的敏感率为71.86%,而对CR-Eco敏感率较低,呋喃妥因及氨基糖苷类抗生素对CR-Eco的敏感率显著高于CR-Kpn。CRE组的院内死亡率与其他两组相比,差异无统计学意义(P＞0.05),不过CRE组预后不良率为19.35%,高于CSE组(11.31%)和控制组(12.15%),差异有统计学意义(P＜0.05)。CRE感染患者中,肾功能不全和使用免疫抑制剂是导致预后不良的独立预测因素,而经验性使用抗生素为预后不良的保护因素。结论 与其他常用抗菌药物相比,黏菌素和替加环素对CRE具有更高的体外抗菌活性,呋喃妥因及氨基糖苷类抗生素适用于CR-Eco导致的感染。医院获得性感染CRE容易导致患者预后不良,而经验性使用抗生素可以有效减少感染CRE导致的不良临床结局。
Abstract
Objective To investigate the drug resistance of carbapenem-resistant enterobacteriaceae (CRE) in hospital-acquired infections and the clinical outcomes of infected patients. Methods A total of 341 adult patients with CRE infection hospitalized in Sichuan Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2017 to June 2023 were selected as the case group, 336 patients with carbapenem sensitive enterobacteriidae (CSE) infection were selected as the sensitive group, and 354 hospitalized patients with non-enterobacteriidae infection during the same period were selected as the control group. The minimum inhibitory concentration of commonly used antibiotics to CRE were detected by drug sensitive strip and broth dilution method, and univariate and multivariate methods were used to analyze the clinical outcomes of hospital-acquired CRE patients. Results The most common types of CRE were sputum, urine and blood, and the top three types of CRE were carbapenem-resistant Klebsiella pneumoniae(CR-Kp), carbapenem-resistant Escherichia coli (CR-Eco) and carbapenem-resistant Enterobacter cloacae (CR-Ecl). Tigecycline and colistin were the top two sensitive drugs of CR-Kpn and CR-Eco in vitro. The sensitivity rate of tetracycline to CR-Kpn was 71.86%, while the sensitivity rate of tetracycline to CR-Eco was low. The sensitivity rate of nitrofuranins and aminoglycosides to CR-Eco was significantly higher than that of CR-Kpn. There was no significant difference in in-hospital mortality between CRE group and the other two groups (P>0.05), but the poor prognosis rate of CRE group (19.35%) was higher than that of CSE group (11.31%) and control group (12.15%), with statistical significance (P<0.05). In patients with CRE infection, renal insufficiency and the use of immunosuppressive agents were independent predictors of poor prognosis, while the empirical use of antibiotics was a protective factor. Conclusions Colistin and tigecycline have higher antibacterial activity against CRE than other commonly used antibiotics. Nitrofurantoin and aminoglycoside antibiotics are suitable for infection caused by CR-Eco. Hospital-acquired CRE infection is prone to lead to poor prognosis in patients, but the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by CRE infection.
关键词
耐碳青霉烯类肠杆菌科细菌 /
耐药性 /
临床结局
Key words
carbapenem-resistant enterobacteriaceae /
drug resistance /
clinical outcome
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