Study On The Risk Factors, Treatment Regimen Options And Prognosis Of CRE Infection

Objective: The problem of bacterial drug resistance has become a serious public health challenge all over the world.There is no definite conclusion on the risk factors and treatment regimen of carbapenem-resistant Enterobacteriaceae(CRE)infection.The purpose of this study is to analyze the risk factors of CRE infection and establish a risk prediction score table,and to analyze the death risk factors of CRE infection and the prognosis of treatment regimen,so as to provide theoretical basis for preventing CRE infection,reducing mortality and choosing treatment regimen.Methods: The medical records of patients with enterobacteriaceae infection in Sichuan people's Hospital from January 2015 to June 2019 were extracted.Firstly,the distribution characteristics of patients with Enterobacteriaceae infection were descriptively analyzed,and then a comparative study of patients with CRE and carbapenem-sensitive Enterobacteriaceae(CSE)infection was conducted according to the standard of nano-excretion at 1:1,and the risk factors of CRE infection were analyzed and the infection risk prediction score table was established.Then the patients who died and survived within 30 days of CRE/CSE infection were compared to explore the death risk factors of CRE/CSE infection.Finally,the treatment outcome and prognosis of CRE infection were analyzed to provide safety information for the choice of treatment regimen for CRE infection.Results: A total of 847 patients(8.40%)with CRE infection were included in this study.the detection rate of CRE in intensive care unit was the highest,which was more prone to infection,and the most common infection was pulmonary infection.Male,advanced age,prolonged hospital stay before infection,large number of complications,previous 3-month history of infection,pre-infection ?-lactamase inhibitor / carbapenem exposure,urinary catheterization and gastric tube(p<0.05)were independent risk factors for CRE infection.A CRE infection risk prediction score table was established,which can accurately predict the probability of CRE infection and effectively distinguish low-risk / high-risk patients.The independent risk factors for death of CRE infection were shorter hospital stay before infection,complicated with pulmonary disease,use of ?-lactamase inhibitor before infection,and combination therapy(p<0.05).The independent risk factors for death of CSE infection were high number of complications,elevated procalcitonin,mechanical ventilation,sputum aspiration,50 mg therapy and carbapenem-based combination therapy(p<0.05),and the independent risk factors of death were the number of complications,elevated procalcitonin,mechanical ventilation,sputum aspiration,tegacycline(50mg)therapy and carbapenem-based combination therapy(p<0.05).The difference in mortality of CRE/CSE infection was significant(11.80% vs 6.49%).The cumulative survival rate was lower,the mortality rate was higher and the prognosis was worse in the CRE infection treatment group with tegacycline or carbapenem,while the tegacycline100mg(high dose)maintenance therapy showed a relatively higher mortality rate.There was no significant difference in the prognosis of patients in the monotherapy or combination therapy group,and there was no significant difference in mortality and prognosis between the monotherapy group and the combination therapy group,and the combination therapy group did not increase the mortality.Conclusion: Intensive care unit has the highest risk of CRE infection and bacterial drug resistance.Previous 3-month infection history and pre-infection carbapenem exposure were the main independent risk factors of CRE infection,minimizing the exposure of infection / death risk factors.Joint risk prediction score scale to evaluate the risk of infection,take the initiative to screen CRE.When selecting carbapenem or tegacycline,there should be clear indications and careful selection of high doses.Clinically,the combination therapy regimen can be chosen directly,and the patient's signs should be closely monitored to reduce the mortality.More research is needed to obtain the information of drug-resistant bacteria,which is of great significance for preventing infection and rational drug use.