| Objectives To understand the distribution and drug resistance characteristics of carbapenem resistant Enterobacteriaceae(CRE)by continuously investigating the clinical distribution characteristics and drug resistance of CRE in our hospital from 2013 to 2017.The clinical characteristics of patients with CRE infection are tracked,and the risk factors of CRE infection are further discussed to formulate effective infection prevention measures,introduce reduction measures for the occurrence and outbreak of nosocomial infection and curb the occurrence of CRE infection.Methods Strain identification and drug susceptibility tests were performed by the use of BD Phoenix-100 automatic bacterial identification/drug susceptibility system,drug susceptibility tests with K-B method.The phenotypes of carbapenemase producing strains were identified by modified Hodge test combined with EDTA synergistic test.127 patients with confirmed infection and complete case data were selected as the case group.Patients infected with carbapenem sensitive Enterobacteriaceae(CSE)at the same time were used as the control group.The case data of patients in CRE group and CSE group,mainly basic information of the patients,basic diseases,antibiotic use,hormone use,invasive device indwelling,admission to intensive care unit and prognosis were tracked respectively.SPSS17.0 software was used to compare the survival rates of patients in CRE group and CSE group.Single-factor and multi-factor Logistic regression analysis was conducted to explore the risk factors of CRE infection.The respiratory tract infection and bloodstream infection with more infection sources were analyzed separately to further explore the risk factors that may cause respiratory tract and bloodstream infection.Results 1 From January 1 2013 to December 31 2017,a total of 1020 CRE strains were detected in our hospital,with a total detection rate of about 5.5%.The detection rates of CRE from 2013 to 2017 were 0.8%(24/2858),8.6%(271/3156),5.9%(249/4205),6.2%(245/3935)and 5.4%(231/4293)respectively.The detection rate of CRE in 2014 was significantly higher than that in 2013.2 Of the 1020 CRE strains,989(96.9%)were Klebsiella pneumoniae.779 Klebsiella pneumoniae strains(76.2%)were isolated from respiratory tract specimens,followed by 87 strains(8.4%)from blood specimens and 45strains(4.5%)from catheter tips.478 strains(46.9%)were from the Department of Critical Care Medicine,followed by 315 strains(30.8%)from the Neurological Intensive Care Unit.3 The results of drug sensitivity tests showed that the drug resistance rates of CRE strains in our hospital to gentamicin,amikacin,compound sulfamethoxazole,polymyxin and tigecycline were 53.2%,39.4%,45.9%,0% and 0% respectively,and the drug resistance rates to other commonly used clinical antibiotics were all higher than 97.5%.4 The mortality rate in CRE infection group was significantly higher than that in CSE infection group(64.2%VS24.8%,P<0.05).Univariate analysis showed that respiratory diseases,hypoproteinemia,pre-infection use of ?-lactam antibiotic(except carbapenems),preinfection use of carbapenems antibiotics,pre-infection use of quinolones antibiotics,preinfection use of hormones,indwelling invasive devices,indwelling central venous catheter,indwelling gastric tube,indwelling urinary catheter,indwelling drainage tube,thoracic intubation,ventilator-assisted mechanical ventilation,and pre-infection admission to ICU were risk factors for CRE infection(P<0.05).Multivariate analysis showed that hypoproteinemia(OR=5.180,P=0.001),carbapenem antibiotics before infection(OR=6.687,P=0.001),indwelling invasive instruments(OR=9.791,P=0.017),and ICU admission before infection(OR=3.150,P=0.033)were risk factors for CRE infection.5 Through the follow-up analysis of CRE respiratory tract infection cases,the results showed that the death rate of CRE respiratory tract infection group was significantly higher than that of CSE respiratory tract infection group(65.8%VS32.3%,P<0.05);Univariate analysis showed that malignant tumor,hypoproteinemia,?-lactam antibiotic(except carbapenems)before infection,use of carbapenems antibiotics before infection,use of quinolones antibiotics before infection,indwelling invasive instruments,indwelling gastric tube,indwelling catheter and admission to ICU before infection were risk factors of CRE respiratory tract infection.Multivariate analysis showed that hypoproteinemia(OR=12.960,P=0.002),carbapenem antibiotics before infection(OR=9.328,P=0.028),and ICU admission before infection(OR=9.887,P=0.006)were risk factors for CRE respiratory tract infection.6 through the follow-up analysis of CRE bloodstream infection cases,the results showed that the death rate of CRE bloodstream infection group was significantly higher than that of CSE bloodstream infection group(73.4%VS23.8%,P<0.05);Univariate analysis showed that hypoproteinemia,use of ?-lactam antibiotic(except carbapenems)before infection,use of carbapenems antibiotics before infection,use of quinolones antibiotics before infection,indwelling invasive instruments,indwelling central venous catheter,indwelling gastric tube,indwelling catheter,indwelling drainage tube,thoracic indwelling tube,ventilator-assisted mechanical ventilation and ICU before infection were risk factors for CRE blood flow infection.Multivariate analysis showed that carbapenem antibiotics(OR=9.091,P=0.020)and indwelling central venous catheter(OR=26.696,P=0.042)were risk factors for CRE bloodstream infection.Conclusions 1 The isolation rate of CRE showed an increasing trend year by year.It was mainly isolated from Department of Critical Care Medicine and Neurological Care Unit.The main sources of infection were respiratory tract and bloodstream infection.2 The mortality rate in CRE infection group was significantly higher than that in CSE infection group(64.2%VS24.8%,P<0.05).Hypoalbuminemia,use of carbapenem antibiotics before infection,indwelling invasive devices,and admission to ICU before infection are risk factors for CRE infection.3 The mortality rate in CRE respiratory tract infection group was significantly higher than that in CSE respiratory tract infection group(65.8%VS32.3%,P<0.05).Further analysis of the risk factors of CRE respiratory tract infection showed that hypoproteinemia,use of carbapenem antibiotics before infection and admission to ICU before infection were the risk factors of CRE respiratory tract infection.4 The mortality rate in CRE bloodstream infection group was significantly higher than that in CSE bloodstream infection group(73.4%VS23.8%,P<0.05).Further analysis of the risk factors of CRE bloodstream infection shows that the use of carbapenem antibiotics and indwelling central venous catheter before infection are the risk factors of CRE bloodstream infection.5 The prevention and control of CRE should be made from many aspects.Clinicians should strictly grasp the indications of antibiotics,minimize the use of carbapenem antibiotics,reduce the duration of ICU stay,avoid central venous indwelling and other invasive operations,shorten the indwelling time of invasive.Such actions help reduce the incidence and mortality rate of CRE infection,or improve the prognosis of patients.Figure4;Table14;Reference 128... |
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