Analysis Of High-risk Factors Of Carbapenem-resistant Enterobacteriaceae Infection In Intensive Care Unit Of Qingdao Municipal Hospital

Objective: The risk factors of Carbapenem-resistant Enterobacteriaceae(CRE)infection in intensive-care unit patients admitted to Qingdao Municipal hospital were analyzed,and the high-risk population of CRE infection was screened,it can detect the source of infection as early as possible,guide the rational use of drugs in clinic,and take isolation measures in time to reduce the cross-transmission of CRE in hospital and reduce the risk of its transmission,to provide more theoretical basis for clinical prevention and control of CRE infection and reduction of bacterial resistance.Methods: The clinical data of patients with CRE infection who met the inclusion and exclusion criteria were collected from January 1,2020 to January 1,2023 in Qingdao Municipal hospital intensive-care unit,the case history data of Carbapenem sensitive Enterobacteriaceae(CSE)group were randomly collected in a ratio of 1:2 as the control group.The patient’s age,sex,length of hospital stay,type of strain,source of specimen,use of hormones,exposure to antibiotics before infection(e.g.Aephalosporins,Aminoglycosides,Carbapenem,Glycopeptides,Quinolones,Tigecycline,Linezolid,etc.),use of Fungicide,co-infection with other pathogens,invasive procedures before infection(e.g.mechanical ventilation,surgery,bronchoscopy,central venous catheter,arterial catheterization,catheter,gastric tube,blood purification,blood transfusion,etc.),enteral nutrition within 72 hours after admission,co-infection with other underlying diseases(hypertension,diabetes,underlying heart disease,chronic lung disease,neurological disorder,malignancy,etc.),Apache Ⅱ score,the infection index(white blood cell count,neutrophil count,lymphocyte count),etc..To explore the risk factors of CRE infection in intensive-care unit patients in Qingdao Municipal hospital.Results: 1.A total of 189 patients with Enterobacteriaceae infection were included in this study,including 121 males and 68 females,aged from 21 to 93 years with an average age of 70.54 ± 15.08 years.In the CRE Group,there were 63 cases,including 56 cases(88.9%)of Klebsiella pneumonia,4 cases(6.3%)of Enterobacter cloacae,2 cases(3.2%)of Proteus mirabilis,and 1 case(1.6%)of Providence Reyi.2.The CRE strains isolated from clinical samples in Qingdao Municipal hospital were mainly from respiratory tract.3.CRE patients in Qingdao Municipal hospital had serious drug resistance to many kinds of antibiotics,even up to 100% to some penicillin antibiotics.4.In univariate analysis,CRE infection was associated with length of hospital stay ≥14 days,Apache Ⅱ score,blood transfusion,complicated infection with other pathogens,combined use of antibiotics,use of aminoglycosides,use of Vancomycin,use of quinolones,use of enzyme inhibitors,use of Linezolid,use of Carbapenem,use of Fungicide,combined with ≥3 underlying diseases,hypertension,brain diseases,mechanical ventilation,blood purification,central venous catheterization,arterial catheterization,gastric catheterization,indwelling catheter,indwelling catheter,bronchoscopy,and lymphocyte level(p < 0.05).5.These meaningful factors were included in the binary Logistic regression model,and the results showed that,the length of hospital stay was ≥14 days,Apache Ⅱ score,infection with other pathogens,brain disease,mechanical ventilation,central venous catheterization,indwelling catheter,Carbapenem use,combined use of antibiotics and low lymphocyte level were independent risk factors for CRE infection(p < 0.05).Conclusion: 1、The length of hospital stay was ≥14 days,Apache Ⅱ score,brain disease,mechanical ventilation,central venous catheterization,indwelling gastric tube,urinary catheter,Carbapenem use,combined use of antibiotics and low lymphocyte level were the independent risk factors of CRE infection in intensive-care unit patients in Qingdao Municipal hospital.2、 Carbapenem-resistant Enterobacteriaceae isolated from intensive-care unit patients in Qingdao Municipal hospital is highly resistant to multiple antibiotics,the suitable antibiotics should be selected according to the drug sensitivity test of clinical patients.