Qiao Fu, Huang Wenzhi, Gao Shan, Cai Lin, Zhu Shichao, Wei Li, Kang Yan, Tao Chuanmin, Zong Zhiyong
Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Infection Control, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
BMJ Open. 2020 Sep 9;10(9):e035893. doi: 10.1136/bmjopen-2019-035893.
To assess the incidence and the impact of carbapenem-resistant (CRAB) intestinal carriage on subsequent CRAB infection and to study risk factors of acquiring CRAB intestinal carriage among patients in intensive care unit (ICU).
Observational study including a case-control study and a retrospective cohort study.
A 50-bed general ICU of a university hospital, China.
From May 2017 to April 2018, an observational study was conducted in a 50-bed general ICU of a university hospital in China. Rectal swabs were collected from ICU patients on admission and thereafter weekly. A case-control study was performed to analyse risk factors of the acquisition of CRAB intestinal carriage in ICU using multiple logistic regression. A retrospective cohort study was performed to address whether intestinal CRAB carriage could lead to an increased likelihood of subsequent CRAB infection using subdistribution hazard model regarding death in the ICU as a competing risk event.
CRAB intestinal carriage was detected in 6.87% (66/961; 95% CI 5.27% to 8.47%) of patients on ICU admission, whereas 11.97% (115/961; 95% CI 9.91% to 14.02%) of patients acquired CRAB intestinal carriage during the ICU stay. Pancreatitis (OR 2.16, 95% CI 1.28 to 3.67), haematological disease (OR 2.26, 95% CI 1.42 to 3.58), gastric tube feeding (OR 3.35, 95% CI 2.03 to 5.51) and use of carbapenems (OR 1.84, 95% CI 1.11 to 3.07) were independent risk factors for acquiring CRAB intestinal carriage. The incidence of subsequent CRAB infection was 2.24-fold in patients with CRAB intestinal carriage compared with that in patients without (95% CI 1.48 to 3.39, p<0.001).
More patients acquired CRAB intestinal carriage during their ICU stay than had on admission. Severity of illness, acute pancreatitis, tube feeding and use of carbapenems were independent risk factors of acquisition of CRAB intestinal carriage. Patients with CRAB intestinal carriage are more likely to develop CRAB infection.
评估耐碳青霉烯类鲍曼不动杆菌（CRAB）肠道定植的发生率及其对随后CRAB感染的影响，并研究重症监护病房（ICU）患者获得CRAB肠道定植的危险因素。
包括病例对照研究和回顾性队列研究的观察性研究。
中国一所大学医院的一间拥有50张床位的综合ICU。
2017年5月至2018年4月，在中国一所大学医院的一间拥有50张床位的综合ICU进行了一项观察性研究。在ICU患者入院时及之后每周采集直肠拭子。采用多因素logistic回归进行病例对照研究，分析ICU中获得CRAB肠道定植的危险因素。采用亚分布风险模型，以ICU死亡作为竞争风险事件，进行回顾性队列研究，以探讨肠道CRAB定植是否会增加随后发生CRAB感染的可能性。
6.87%（66/961；95%CI 5.27%至8.47%）的ICU入院患者检测到CRAB肠道定植，而11.97%（115/961；95%CI 9.91%至14.02%）的患者在ICU住院期间获得了CRAB肠道定植。胰腺炎（比值比2.16，95%CI 1.28至3.67）、血液系统疾病（比值比2.26，95%CI 1.42至3.58）、鼻饲（比值比3.35，95%CI 2.03至5.51）和碳青霉烯类药物的使用（比值比1.84，95%CI 1.11至3.07）是获得CRAB肠道定植的独立危险因素。与未发生CRAB肠道定植的患者相比，发生CRAB肠道定植的患者随后发生CRAB感染的发生率高2.24倍（95%CI 1.48至3.39，p<0.001）。
在ICU住院期间获得CRAB肠道定植的患者比入院时更多。疾病严重程度、急性胰腺炎、鼻饲和碳青霉烯类药物的使用是获得CRAB肠道定植的独立危险因素。发生CRAB肠道定植的患者更有可能发生CRAB感染。
