Analysis Of The Risk Factors For Carbapenem-resistant Enterobacteriaceae Infection In The Intensive Care Unit

ObjectiveAnalyze the risk factors of carbapenem-resistant enterobacteriaceae(CRE)infection in the intensive care unit(ICU),provide early warning for the occurrence of CRE in critically ill patients,adjust the treatment plan,and isolate early to prevent transmission.MethodsA retrospective analysis of sepsis patients(n=195)who met the sepsis 3.0diagnostic criteria admitted to the emergency ICU of the First Affiliated Hospital of Dalian Medical University from December 2017 to December 2020 was used to determine whether the patients had CRE infection.According to whether the patients were infected with CRE,they were divided into CRE infection group(n=107)and non-CRE infection group(n=88).Collect the basic characteristics of patients.Record whether the patients had basic diseases such as diabetes,hypertension,tumor,lung disease,kidney disease,liver disease,etc.Record whether the patients had undergone invasive treatments such as tracheal intubation,central venous catheterization,gastric tube insertion,urinary catheterization,etc.Record whether the patients had undergone surgery and the patients’ antibiotic application status.Record whether the patients received enteral nutrition within 72 hours of admission.Collect infection-related indicators on the day of patients enrollment,including white blood cell(WBC),neutrophil(N),lymphocyte(L),procalcitonin(PCT),and calculate the neutrophil to lymphocyte ratio(NLR)and sequential organ failure score(SOFA).Collect other indicators on the day of patients enrollment,including hemoglobin(HB),platelet(PLT),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),albumin(ALB),urea(Urea),serum creatinine(Scr).Categorical variables were compared using χ2 test,and non-categorical variables were compared using Mann-Whitney U test.Logistic multivariate regression analysis was used to evaluate independent risk factors for CRE infection.The receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)was calculated to evaluate the value of various factors in predicting CRE infection,and to determine the best cut-off value.ResultsThere were statistically significant differences in age,received invasive treatments(tracheal intubation,central venous catheterization,gastric tube insertion,urinary catheterization),application of carbapenem antibiotics,combined application of antibacterial drugs,enteral nutrition within 72 hours of admission,WBC,N,L,NLR,PCT,SOFA score,HB,ALT,ALB,Urea between the CRE infection group and the non-CRE infection group(P<0.05).The number of patients in the CRE infection group who received invasive treatment(tracheal intubation,central venous catheterization,gastric tube insertion,urinary catheterization),carbapenem antibiotics,combined application of antibacterial drugs,and no enteral nutrition within 72 hours after admission were significantly higher than those in the non-CRE infection group.The age,WBC,N,NLR,PCT,SOFA score,ALT and Urea of the CRE infection group were significantly higher than those of the non-CRE infection group(P<0.05).The L,HB and ALB of the CRE infection group were significantly lower than those of the non-CRE infection group(P<0.05).There was no statistical difference between the two groups in gender,whether surgery was performed,whether there were underlying diseases(diabetes,hypertension,tumor,etc),as well as PLT,AST,TBIL and Scr(P>0.05).The results of logistic multivariate regression analysis showed that the patient’s age,WBC,N,L,NLR,SOFA score,no enteral nutrition within 72 hours of admission,and combined application of antibacterial drugs were all independent risk factors for CRE infection in the ICU(P<0.05).Among them,the patient’s age,WBC,N,NLR,SOFA score,combined application of antibacterial drugs were positively correlated with the occurrence of CRE,and L,enteral nutrition within 72 hours of admission were negatively correlated with the occurrence of CRE.ROC analysis showed that the AUC of NLR was 0.765,which was higher than SOFA score,L,N,age and WBC.When the NLR cut-off value was 11.285,the sensitivity of NLR to predict CRE infection was 68.2%,and the specificity was 79.5%.Conclusions1.The absence of enteral nutrition within 72 hours after admission,combined application of antibacterial drugs,NLR,SOFA score,age,etc in the patients with sepsis are all independent risk factors for CRE infection in the ICU.Among them,NLR has the greatest predictive effect on the occurrence of CRE infection in the patients with sepsis in the ICU.2.For elderly patients with severe infections,early administration of enteral nutrition and reasonable application of antibacterial drugs can prevent the occurrence of CRE infection to a certain extent.