Zhu Rongping, Xu Xiaohong, Lian Siyan, Cai Meili, Zhang Hui, Chen Xin, Cao Yingping
Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People's Republic of China.
Fujian Medical University, Fuzhou, 350001, People's Republic of China.
Infect Drug Resist. 2022 Aug 6;15:4275-4283. doi: 10.2147/IDR.S376413. eCollection 2022.
Carbapenem-resistant Enterobacteriaceae (CRE) colonization is associated with bacterial translocation, which can result in subsequent endogenous CRE infection. In the present study, we aim to investigate the colonization-related risk factors and molecular epidemiological characteristics of CRE in patients with acute leukemia.
From January 2021 to December 2021, acute leukemia patients were screened for CRE by fecal/perianal swabs. We identified the species, carbapenemase-encoding genes, and virulence genes of the colonizing strains and performed antimicrobial susceptibility tests and ERIC-PCR typing. Risk factors for CRE colonization were identified by univariate and multivariate analysis.
We collected a total of 21 colonizing strains from 320 patients. All strains were resistant to meropenem. was the most abundant species, and ERIC-PCR typing showed low diversity. Univariate analysis showed that age, cephalosporins, penicillins, tigecyclines, and hematopoietic stem cell transplantation status were risk factors for CRE colonization; simultaneously discovered CRE strains played a dominant role in invasive infection of colonized patients. Logistic multivariate regression analysis showed that age, cephalosporins, and tigecyclines were independent risk factors for CRE intestinal colonization.
CRE colonization can increase the incidence of CRE infection in patients with acute leukemia. Early detection of CRE colonization through CRE screening is an important measure to control the spread of CRE.
耐碳青霉烯类肠杆菌科细菌（CRE）定植与细菌易位有关，这可能导致随后的内源性CRE感染。在本研究中，我们旨在调查急性白血病患者中CRE的定植相关危险因素和分子流行病学特征。
2021年1月至2021年12月，通过粪便/肛周拭子对急性白血病患者进行CRE筛查。我们鉴定了定植菌株的种类、碳青霉烯酶编码基因和毒力基因，并进行了药敏试验和ERIC-PCR分型。通过单因素和多因素分析确定CRE定植的危险因素。
我们共从320例患者中收集了21株定植菌株。所有菌株均对美罗培南耐药。 是最主要的菌种，ERIC-PCR分型显示多样性较低。单因素分析显示，年龄、头孢菌素、青霉素、替加环素和造血干细胞移植状态是CRE定植的危险因素；同时发现CRE菌株在定植患者的侵袭性感染中起主导作用。Logistic多因素回归分析显示，年龄、头孢菌素和替加环素是CRE肠道定植的独立危险因素。
CRE定植可增加急性白血病患者CRE感染的发生率。通过CRE筛查早期发现CRE定植是控制CRE传播的重要措施。
