Yuan Youhua, Wang Junjie, Yao Zonghui, Ma Bing, Li Yi, Yan Wenjuan, Wang Shanmei, Ma Qiong, Zhang Jiangfeng, Xu Junhong, Li Li, Wang Yuming, Fan Enguo
Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China.
Clinical Laboratory, Luyi Zhenyuan Hospital, Zhoukou, Henan 477200, People's Republic of China.
Infect Drug Resist. 2020 Jan 22;13:207-215. doi: 10.2147/IDR.S223243. eCollection 2020.
The incidence of carbapenem-resistant (CRKP) bloodstream infections (BSIs) is increasing globally; however, little has been reported on the risk factors and outcomes of CRKP BSIs in central China. This study aimed to determine the clinical risk factors for CRKP BSIs and the outcomes of CRKP BSIs.
We performed a case-control study of 239 patients with BSIs who were treated at Henan Provincial People's Hospital between July 2017 and July 2018. The cases (n=98, 41%) had CRKP BSIs, and the controls (n=141, 59%) had non-carbapenem-resistant (non-CRKP) BSIs. Antimicrobial sensitivity was determined using automated broth microdilution and an agar disk diffusion method. Data were obtained from clinical and laboratory records. Multivariate logistic regression and Pearson chi-square tests were used to identify clinical factors and outcomes associated with carbapenem resistance.
Risk factors for carbapenem resistance included recent carbapenem use (odds ratio [OR]: 9.98, 95% confidence interval [CI]: 5.2-17.1, <0.001), invasive procedures (OR: 11.1, 95% CI: 3.3-37.7, <0.001), and pre-existing diseases of the digestive system (OR: 8.22, 95% CI: 1.73-39.2, =0.008). Treatment failure was more frequent in the cases (84.7%) than in the controls (32.6%).
Exposure to antibiotics, especially carbapenems, and invasive procedures were the major risk factors for carbapenem resistance among patients with BSIs. Strict control measures should be implemented to prevent the emergence and spread of CRKP.
耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染（BSIs）的发病率在全球范围内呈上升趋势；然而，关于中国中部地区CRKP血流感染的危险因素和转归的报道较少。本研究旨在确定CRKP血流感染的临床危险因素及CRKP血流感染的转归。
我们对2017年7月至2018年7月在河南省人民医院接受治疗的239例血流感染患者进行了病例对照研究。病例组（n = 98，41%）为CRKP血流感染，对照组（n = 141，59%）为非耐碳青霉烯类（non-CRKP）血流感染。采用自动肉汤微量稀释法和琼脂纸片扩散法测定抗菌药物敏感性。数据来自临床和实验室记录。采用多因素logistic回归分析和Pearson卡方检验确定与碳青霉烯类耐药相关的临床因素和转归。
碳青霉烯类耐药的危险因素包括近期使用碳青霉烯类药物（比值比[OR]：9.98，95%置信区间[CI]：5.2 - 17.1，<0.001）、侵入性操作（OR：11.1，95% CI：3.3 - 37.7，<0.001）和既往消化系统疾病（OR：8.22，95% CI：1.73 - 39.2，=0.008）。病例组治疗失败的发生率（84.7%）高于对照组（32.6%）。
暴露于抗生素，尤其是碳青霉烯类药物，以及侵入性操作是血流感染患者碳青霉烯类耐药的主要危险因素。应实施严格的控制措施以预防CRKP的出现和传播。
