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2014年至2019年期间，超广谱β-内酰胺酶（ESBL）的产生和碳青霉烯类耐药性增加了土耳其重症监护病房的继发性血流感染率。

ESBL production and carbapenem resistance increased the secondary bloodstream infection rates in intensive care units in Turkey, 2014-2019.

作者信息

Hekimoglu Can Huseyin, Yildiz Serap Suzuk, Sahan Selda, Batir Esen, Yildirim Gozel Emine, Altun Dilek, Pehlivanturk Gulen, Comce Muhammet, Kara Fatih

机构信息

Ministry of Health, General Directorate of Public Health, Department of Communicable Diseases, Ankara, Turkey.

Ministry of Health, General Directorate of Public Health, Department of Microbiology Reference Laboratory and Biological Products, Ankara, Turkey.

出版信息

GMS Hyg Infect Control. 2022 Apr 11;17:Doc05. doi: 10.3205/dgkh000408. eCollection 2022.

DOI:10.3205/dgkh000408
PMID:35707227
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9174877/
Abstract

AIM

Secondary bloodstream infections (SBSIs) are caused by another infection and differ from primary bloodstream infections (PBSIs) in terms of prevention and treatment strategies. The aim of this study was to determine the risk factors for bloodstream infections which were secondary to the most common healthcare-associated infections caused by the most common microorganisms in intensive care units (ICUs) and to examine whether extended-spectrum beta lactamase (ESBL) production and carbapenem resistance is related to the higher risk or not.

METHODS

The study population consisted of patients in ICUs with ventilator-associated pneumonia (VAP), ventilator-associated event (VAE) or catheter-associated urinary tract infection (CAUTI) caused by or between 2014 and 2019. The data were obtained through the National Healthcare-associated Infections Surveillance Network. Multivariate logistic regression analysis was performed separately for VAP/VAE and CAUTI to determine the risk factors for the development of SBSI.

RESULTS

Microorganism, ICU type, bed capasity and carbapenem resistance were found to be risk factors for SBSI for both types of infection. For VAPs/VAEs, female gender and hospital type were also identified as risk factors. The highest risk was in and in emergency ICUs. Among the hospitals, the highest risk in VAPs/VAEs was found in government education and research hospitals. ESBL production for . and increased the risk in patients with VAP/VAE; however, it did not increase in patients with CAUTI.

DISCUSSION

By using the risk factors, it may be possible to recognize SBSIs earlier, especially in patients with CAUTIs or VAPs/VAEs caused by carbapenem-resistant or ESBL-producing .

摘要

目的

继发性血流感染（SBSIs）由另一种感染引起，在预防和治疗策略方面与原发性血流感染（PBSIs）不同。本研究的目的是确定重症监护病房（ICU）中由最常见微生物引起的最常见医疗相关感染继发的血流感染的危险因素，并检查超广谱β-内酰胺酶（ESBL）产生和碳青霉烯耐药性是否与较高风险相关。

方法

研究人群包括2014年至2019年期间因[具体微生物1]或[具体微生物2]导致呼吸机相关性肺炎（VAP）、呼吸机相关性事件（VAE）或导管相关性尿路感染（CAUTI）的ICU患者。数据通过国家医疗相关感染监测网络获得。对VAP/VAE和CAUTI分别进行多变量逻辑回归分析，以确定SBSI发生的危险因素。

结果

发现微生物、ICU类型、床位容量和碳青霉烯耐药性是两种感染类型中SBSI的危险因素。对于VAPs/VAEs，女性性别和医院类型也被确定为危险因素。[具体微生物1]和[具体微生物2]导致的感染风险最高，在急诊ICU中也是如此。在医院中，VAPs/VAEs风险最高的是政府教育和研究医院。[具体微生物1]、[具体微生物2]和[具体微生物3]产生ESBL增加了VAP/VAE患者的风险；然而，CAUTI患者的风险并未增加。

讨论

通过使用这些危险因素，有可能更早地识别SBSIs，特别是在由耐碳青霉烯或产ESBL的[具体微生物1]或[具体微生物2]引起的CAUTIs或VAPs/VAEs患者中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/8d3c3dd28941/HIC-17-05-g-004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/a79ef448b059/HIC-17-05-t-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/c235e8263734/HIC-17-05-t-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/9b5e880f20e2/HIC-17-05-g-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/377d2f5b12a7/HIC-17-05-g-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/ba8ec5e5366d/HIC-17-05-g-003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/8d3c3dd28941/HIC-17-05-g-004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/a79ef448b059/HIC-17-05-t-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/c235e8263734/HIC-17-05-t-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/9b5e880f20e2/HIC-17-05-g-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/377d2f5b12a7/HIC-17-05-g-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/ba8ec5e5366d/HIC-17-05-g-003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f599/9174877/8d3c3dd28941/HIC-17-05-g-004.jpg

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