重症监护病房患者碳青霉烯类耐药肠杆菌科细菌肠道定植和感染的情况调查及影响因素分析

Investigation of Intestinal Colonization and Infection of Carbapenem Resistant Enterobacteriaceae in Intensive Care Unit Patients and Analysis of Influencing Factors

摘要: 目的：了解我院重症医学科(Intensive Care Unit, ICU)患者碳青霉烯类耐药肠杆菌科细菌(Carbapenem-resistant Enterobacterales, CRE)肠道定植情况，分析我院ICU患者CRE肠道定植、ICU患者CRE感染的影响因素；分析ICU患者CRE肠道定植与CRE感染的相关性。方法：收集2022年10月至2023年7月入住我院ICU并符合纳入与排除标准的197例患者，对其进行常规肛拭子筛查，记录患者的一般临床资料、生化指标等，根据筛查结果将患者分为CRE肠道定植组和CRE非定植组，根据患者此次住院期间是否发生感染，分为CRE感染组和非CRE感染组；对相关影响因素进行单因素分析及二元Logistic回归分析。结果：我院ICU患者CRE肠道定植率为10.2% (20/197)，定植菌株类型以克雷伯菌属为主，耐药机制以产金属酶为主，替加环素的耐药率最低；CRE感染率为4.1% (8/197)，CRE感染菌株类型以克雷伯菌属为主，耐药机制中以产丝氨酸酶占为主，替加环素的耐药率最低；格拉斯哥昏迷量表(Glasgow Coma Scale, GCS)评分偏高，转诊病房个数 ≥ 2个、入住ICU次数多、有碳青霉烯类药物暴露史、住院期间使用抗生素种类较多、天数较长，存在各种引流管是ICU患者CRE肠道定植的危险因素；转诊病房个数 ≥ 2个、住院期间抗生素使用种类 ≥ 3种，是ICU患者CRE感染的危险因素；肛拭子主动筛查与CRE感染存在一致性，肛拭子主动筛查在一定程度上可以预测CRE感染情况。结论：GCS评分偏高，转诊病房个数 ≥ 2个、入住ICU次数多、住院期间使用抗生素种类 ≥ 3个、使用天数较长，存在各种引流管的这部分ICU患者更易发生CRE肠道定植；转诊病房个数 ≥ 2个、住院期间抗生素使用种类 ≥ 3种两部分ICU患者在住院期间越易发生CRE感染；CRE感染和CRE肠道定植存在相关性，CRE肠道定植的患者更易发生CRE感染。

Abstract: Objective: To understand the intestinal colonization of Carbapenem-resistant Enterobacterales (CRE) in patients in the Intensive Care Unit (ICU) of our hospital, analyze the influencing factors of intestinal colonization of CRE and CRE infection in ICU patients, and analyze the correlation between intestinal colonization of CRE and CRE infection in ICU patients. Method: A total of 197 patients admitted to ICU of our hospital from October 2022 to July 2023 who met the inclusion and exclusion criteria were collected. Routine anal swab screening was performed on them, general clinical data and biochemical indicators of the patients were recorded, and the patients were divided into CRE intestinal colonization group and CRE non-colonization group according to the screening results. They were divided into CRE infection group and non-CRE infection group. Univariate analysis and binary Logistic regression analysis were performed for the relevant influencing factors. Results: The intestinal colonization rate of CRE in ICU patients in our hospital was 10.2% (20/197). The colonized strains were mainly Klebsiella, the resistance mechanism was mainly metalloenzyme production, and the resistance rate of tigecycline was the lowest. The infection rate of CRE was 4.1% (8/197). Klebsiella was the main type of CRE infection strain, serinase was the main resistance mechanism, and tigecycline had the lowest resistance rate. Glasgow Coma Scale (GCS) score was high, the number of referral wards was ≥2, the number of hospitalization in ICU, the history of carbapenem exposure, the number of antibiotics used during hospitalization, the number of days, the presence of various drainage tubes were the risk factors for CRE colonization in ICU patients. The number of referral wards ≥2 and the types of antibiotics used ≥3 during hospitalization were risk factors for CRE infection in ICU patients. Anal swab active screening is consistent with CRE infection, and anal swab active screening can predict CRE infection to some extent. Conclusions: Patients with high GCS score, more than 2 referred wards, more ICU admission times, ≥ 3 antibiotic types used during hospitalization, and longer use days were more likely to develop intestinal colonization of CRE. The number of referral wards ≥2 and the types of antibiotics used ≥3 during hospitalization were more likely to develop CRE infection during hospitalization. There is a correlation between CRE infection and CRE intestinal colonization, and patients with CRE intestinal colonization are more likely to develop CRE infection.