Wang Xinchun, Li Qi, Kang Jianbang, Yin Donghong, Li Xiaoxia, Wang Shuyun, Guo Qian, Song Yan, Wang Jing, Duan Jinju
Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
Department of Pharmacy, Shanxi Medical University, Taiyuan, People's Republic of China.
Infect Drug Resist. 2022 Jun 20;15:3225-3237. doi: 10.2147/IDR.S366808. eCollection 2022.
The data from the China Network Antibacterial Surveillance Center (http://www.chinets.com) showed that the prevalence of (), (KP), and (ecl), was 18.96%, 14.12%, and 2.74% in 2022, respectively. The resistance rates of and KP to 3rd or 4th generation cephalosporins were 51.7% and 22.1%, to carbapenems was 1.7% and 3.9%, to quinolones was 55.9% in Shanxi. The generation of extended-spectrum beta-lactamases (ESBLs) is a major mechanism resulting in drug resistance in . To determine the mortality risk factors of multi-drug resistant (MDRE) and multi-drug resistant (MDR-KP) infection.
91 MDR strains from 91 patients were collected from 2015 to 2019 in the second hospital of Shanxi Medical University. The mortality risk factors for the MDRE infections and clinical outcomes were analyzed by univariable and multivariable analysis. The independent predictors of 30-day mortality were analyzed through the Cox regression analysis including the variables with a value <0.2.
The majority of patients were admitted to ICUs. Pulmonary infection was a major infection (43.96%, 40/91). Thirty-three (36.26%, 33/91) strains of MDR-KP were only detected in 2018. The proportion of multi-drug resistant (MDR ) and multi-drug resistant (MDR ecl) were 16.48% (15/91) and 17.58% (16/91), respectively. The presence of cerebrovascular diseases (OR, 4.046; 95%Cl, 1.434-11.418; P=0.008) and central venous catheterization (OR, 4.543; 95%Cl, 1.338-15.425; P=0.015) were associated with mortality in patients with MDRE infections. Endotracheal intubation (OR, 4.654; 95%Cl, 1.5-14.438; P=0.008) was an independent mortality risk factor for patients infected with MDR-KP strains. Patients who received aminoglycoside antibiotics (P=0.057) had a higher 30-day survival rate. The β-lactam antibiotics were the major agent in the clinic.
This study implies that patients with cerebrovascular diseases, central venous catheterization, and endotracheal intubation are at risk of carrying MDR isolates.
2015年至2019年在山西医科大学第二医院收集了91例患者的91株多重耐药菌株。通过单因素和多因素分析对MDRE感染的死亡风险因素和临床结局进行分析。通过Cox回归分析包括值<0.2的变量来分析30天死亡率的独立预测因素。
大多数患者入住重症监护病房。肺部感染是主要感染类型（43.96%，40/91）。2018年仅检测到33株（36.26%，33/91）MDR-KP菌株。多重耐药肺炎克雷伯菌（MDR ）和多重耐药产超广谱β-内酰胺酶肠杆菌科细菌（MDR ecl）的比例分别为16.48%（15/91）和17.58%（16/91）。脑血管疾病（OR，4.046；95%CI，1.434-11.418；P=0.008）和中心静脉置管（OR，4.543；95%CI，1.338-15.425；P=0.015）与MDRE感染患者的死亡率相关。气管插管（OR，4.654；95%CI，1.5-14.438；P=0.008）是感染MDR-KP菌株患者的独立死亡风险因素。接受氨基糖苷类抗生素治疗的患者（P=0.057）30天生存率较高。β-内酰胺类抗生素是临床主要用药。
本研究表明，患有脑血管疾病、中心静脉置管和气管插管的患者携带多重耐药菌株的风险较高。
