| Background With the increasing incidence of Carbapenem-resistant Enterobacteriaceae(CRE)infection year by year,the increase of drug resistance,limited drug treatment options and high mortality rate,it has become the most difficult bacterial to control in hospital-acquired infection(HAI)except carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa in recent years.HAI is more common among patients in intensive care units because of their critical illness,relatively immunosuppression,and undering invasive operations frequently.Some studies have found that severe underlying diseases,higher illness severity score,use of various anti-infective drugs before infections,and invasive procedures are associated with CRE infection in ICU patients,but the conclusions of different regions are inconsistent.Moreover,with the attention that medical institutions attach to CRE carriage and the implementation of effective prevention and control measures,the epidemiology of CRE is also changing accordingly.Knowing the epidemiology and risk factors of CRE is helpful to the prevention and control of CRE infection.Objective Analyzing the clinical characteristics of patients in intensive care units(ICU)who were infected with carbapenem-resistant Enterobacteriaceae(CRE),to understand its epidemiology and susceptibility features and to explore the risk factors.Methods The clinical data of 133 patients who were infected CRE in the four ICU wards(First Department of Critical Care Medicine,Second Department of Critical Care Medicine,Emergency Intensive Care Unit,Respiratory and Critical Care Medicine Care Unit)of the Second Hospital of Anhui Medical University from January 2018 to December 2020 were collected,and 220 patients who were infected carbapenem-susceptible Enterobacteriaceae(CSE)as a control group,the distribution and drug resistance of CRE pathogens were analyzed.To determine the risk factors for CRE infection,univariate and multivariate logistic regression analyses were performed.Results Among the CRE infection in ICU patients,respiratory infections were the most common(69.9%),followed by bloodstream infections(7.5%),intra-abdominal infections(6.8%)and urinary system infection(6.0%).The top three CRE strains were Klebsiella pneumoniae(85/133,63.9%),Enterobacter cloacae(20/133,15.0%)and Serratia marcescens(8/133,6.0%)successively.The 30-day mortality of patients in ICUs after CRE infections was 41.6%,and the mortality of CSE group was 27.1%,and the difference was statistically significant(χ~2=7.407,P=0.006).The CRE strains showed 100%resistant to meropenem and ertapenem,the resistance rate of CRE strains to imipenem was 97.0%;the lowest resistance rate among cephalosporins is cefepime,which is 94.7%;as for the commonly usedβ-lactams/β-lactamase inhibitors,the drug resistance rate of piperacillin-tazobactam is the lowest,which is 93.9%.Relatively speaking,the resistance rate of CRE to tobramycin,cotrimoxazole and amikacin is slightly lower,which were 80.0%,72.2%and 51.5%,respectively.CRE showed high sensitivity to ceftazidim,polymyxin B and tigecycline at 69.7%,97.1%and 97.9%,respectively.Multivariate logistic regression analysis showed that patients transferred to ICU from another hospital(OR[95%CI]:3.014[1.299-6.997],P=0.010),exposure to glucocorticoids(OR[95%CI]:1.900[1.032-3.499],P=0.039),carbapenems(OR[95%CI]:2.668[1.406-5.064],P=0.003)and glycopeptides(OR[95%CI]:2.412([1.339-4.345],P=0.003)before infection were independent risk factors for CRE infection in ICU patients.Conclusions To control and treat CRE effectively,phenotypic or genotypic detections of CRE carbapenemase are urgently needed,nosocomial infection prevention and control of CRE may be threatened by Enterobacter cloacae in the future.This study proposes that,CRE nosocomial infections in ICU patients are sitll in grave difficults.CRE screening CRE of high-risk patients regularly,useing anti-infective drugs and glucocorticoids rationally can reduce CRE nosocomial infections in ICU patients. |
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