Zhang A R, Wang Q, Zhou C E, Zhang J G, Wang X J, Zhao J K, Lu B H, Yang C X, Gu L, Ma L Y, Su J R, Cao B, Wang H
Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China.
Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2021 Jun 8;101(21):1572-1582. doi: 10.3760/cma.j.cn112137-20201224-03455.
To explore the risk factors for carbapenem-resistant (CRE) infection and death. A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group (247), and infected by carbapenem susceptible (CSE) as the control group (235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis. CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation (2.607, 95: 1.655-4.108, 0.001), empirical treatment using third or fourth generation cephalosporins (2.339, 95: 1.438-3.803, 0.001), carbapenems (2.468, 95: 1.610-3.782, 0.001) and quinolones (2.042, 95: 1.268-3.289, 0.003) were independent risk factors for CRE infection. Mechanical ventilation (3.390, 95: 1.454-7.904, 0.005), heart failure (4.679, 95: 1.975-11.083, 0.001), moderate or severe liver disease (3.057, 95: 1.061-8.806, 0.038), prior 30-day quinolones exposure (2.882, 95: 1.241-6.691, 0.014) and septic shock (7.772, 95: 3.505-17.233, 0.001) were independent risk factors for death after CRE infection. Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.
探讨耐碳青霉烯类肠杆菌科细菌（CRE）感染及死亡的危险因素。对2018年北京18家二级或三级医院的482例住院患者进行了病例对照分析。选择CRE感染患者作为病例组（247例），碳青霉烯类敏感菌（CSE）感染患者作为对照组（235例）。通过单因素分析和多因素logistic回归分析CRE感染的危险因素及临床预后。CRE对多数抗菌药物耐药，但对黏菌素和替加环素高度敏感，敏感性分别为94.0%和99.5%。多因素分析显示，30天内曾行气管插管（2.607，95%CI：1.655 - 4.108，P = 0.001）、使用第三代或第四代头孢菌素进行经验性治疗（2.339，95%CI：1.438 - 3.803，P = 0.001）、使用碳青霉烯类药物（2.468，95%CI：1.610 - 3.782，P = 0.001）及喹诺酮类药物（2.042，95%CI：1.268 - 3.289，P = 0.003）是CRE感染的独立危险因素。机械通气（3.390，95%CI：1.454 - 7.904，P = 0.005）、心力衰竭（4.679，95%CI：1.975 - 11.083，P = 0.001）、中度或重度肝病（3.057，95%CI：1.061 - 8.806，P = 0.038）、30天内曾使用喹诺酮类药物（2.882，95%CI：1.241 - 6.691，P = 0.014）及感染性休克（7.772，95%CI：3.505 - 17.233，P = 0.001）是CRE感染后死亡的独立危险因素。减少抗菌药物的使用以及如30天内曾行气管插管等侵入性操作可能会降低CRE感染的概率。对CRE感染患者的基础疾病严重程度进行分级，以及预测和预防感染性休克的发生将有助于降低死亡风险。
