Asai Nobuhiro, Sakanashi Daisuke, Suematsu Hiroyuki, Kato Hideo, Hagihara Mao, Nishiyama Naoya, Koizumi Yusuke, Yamagishi Yuka, Mikamo Hiroshige
Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Aichi, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Aichi, Japan.
J Infect Chemother. 2018 Jul;24(7):505-509. doi: 10.1016/j.jiac.2018.02.005. Epub 2018 Mar 13.
While the emergence and spread of carbapenem-resistant enterobacteriaceae (CRE) carriage and infections are serious threats to public health worldwide, its prevalence and epidemiology are still unknown.
For the purpose of examining the prevalence, patients' background and risk factors for CRE carriage and infections, we conducted this case-control study. We retrospectively reviewed all patients isolating CRE at Aichi Medical University hospital from January 2010 until March 2017. The patients isolated with carbapenem-susceptible enterobacteriaceae (CSE) were randomly selected during the study period.
A total of 26 patients, isolating 28 CRE infections were enrolled in this study. The detection rate of CRE carriage and infection was 0.22% (28/12,600). Compared to the CSE group, the CRE group had poorer PS and higher CCI scores. The CRE group tended to stay longer in hospital (121 v.s. 63 days, p = 0.052) and admission fee was much more expensive than CSE group (220,710 v.s. 69,904 JPY, p < 0.001). PS 2-4 (ECOG) and CCI≧3 (p = 0.002), prior hospitalization within 90 days (p = 0.006) and prior antibiotics use within 90 days (p = 0.005) were risk factors for acquisition of CRE by univariate analysis. The combination of PS 2-4 and CCI≧3 was an independent risk factor for CRE carriage and infection by multivariate logistic regression analysis.
The combination of PS 2-4 (ECOG) and CCI score≧3 was an independent risk factor of CRE carriage and infections. The CRE group tended to stay longer in hospital, and the medical expense was much more expensive than those in the CSE group.
虽然耐碳青霉烯类肠杆菌科细菌（CRE）携带及感染的出现和传播对全球公共卫生构成严重威胁，但其流行情况和流行病学特征仍不明确。
为了研究CRE携带及感染的流行情况、患者背景和危险因素，我们开展了这项病例对照研究。我们回顾性分析了2010年1月至2017年3月在爱知医科大学医院分离出CRE的所有患者。在研究期间随机选取分离出碳青霉烯类敏感肠杆菌科细菌（CSE）的患者。
本研究共纳入26例患者，分离出28例CRE感染。CRE携带及感染的检出率为0.22%（28/12,600）。与CSE组相比，CRE组的体能状态（PS）较差，合并症指数（CCI）得分较高。CRE组的住院时间往往更长（121天对63天，p = 0.052），入院费用比CSE组高得多（220,710日元对69,904日元，p < 0.001）。单因素分析显示，PS 2 - 4（东部肿瘤协作组）和CCI≥3（p = 0.002）、90天内曾住院（p = 0.006）以及90天内曾使用抗生素（p = 0.005）是获得CRE的危险因素。多因素逻辑回归分析显示，PS 2 - 4和CCI≥3的组合是CRE携带及感染的独立危险因素。
PS 2 - 4（东部肿瘤协作组）和CCI得分≥3的组合是CRE携带及感染的独立危险因素。CRE组的住院时间往往更长，医疗费用比CSE组高得多。
