Study On Active Screening Of Anal Swabs And ICU CRE Infection In Qinghai Area

Objective: To preliminarily understand the CRE colonization rate and infection rate of high-risk patients in the intensive care department of Qinghai University Affiliated Hospital by conducting anal swab CRE active screening in the Department of Critical Care Medicine,Affiliated Hospital of Qinghai University;to compare the correlation between CRE colonization and CRE infection;to evaluate the correlation between the length of stay in the ICU and the detection rate of CRE;the high-risk factors of CRE infection in patients in the intensive care unit;the distribution characteristics of CREresistant enzymes in the intensive care department to guide the use of clinical antibiotics.Methods: In this study,active screening measures were adopted,and patients admitted to the Department of Critical Care Medicine of Qinghai University Affiliated Hospital from December 2020 to December 2021 were screened by anal swabs according to the inclusion and exclusion criteria.Then collect CRE screening results.According to the results,the patients were divided into a CRE colonization group and a CRE noncolonization group.According to whether the patients had infection during hospitalization,they were divided into a CRE infection group and a non-CRE infection group.The relevant clinical data of the patients(general situation,treatment and operation,various Scores,biochemical indicators,infection indicators,vital signs,etc.),and SPSS 25.0 statistical software was used to analyze the above data.Results: From December 2020 to December 2021,a total of 296 patients were actively screened with CRE anal swabs,and the CRE colonization rate was 6.1%(18/296),mainly NDM-producing Escherichia coli;CRE infection rate was 2.0%(6/296),mainly NDM-producing Klebsiella pneumoniae.The patients mainly came from the emergency department.Most of the CRE colonization was detected in ≤7 days,and the majority of CRE infection was detected in ≥7 days.The results of the consistency analysis of CRE colonization and infection Kappa=0.312,P=0.000,there is a certain consistency between CRE colonization and infection,and anal swabs have a certain sensitivity as an active CRE screening method.The patients were divided into colonization group and non-colonization group for comparison: the CRE colonization group was significantly higher than the non-colonization group in terms of length of stay,SOFA score,laparotomy,and organs involved at admission,and the difference was statistically significant(P<0.05);the patients were then divided into infection group and non-infection group for comparison: the CRE infection group was significantly higher than the non-infection group in terms of length of stay,ICU stay,APACHE II score,SOFA score,and laparotomy,and the difference was statistically significant.(P<0.05).The length of hospital stay,SOFA score,and laparotomy were risk factors for CRE colonization and infection,P<0.05,and the OR value was statistically significant.Drug resistance mechanisms play an important role in the choice of CRE treatment regimens.Tigecycline could be the basis choice of CRE treatment in this study.Ceftazidime/avibactam can be the preferred choice for the treatment of KPC-type carbapenemase-producing CRE strains.Conclusion: CRE colonization is an independent risk factor for CRE infection;active anal swab screening can be used as an active monitoring method for CRE colonization and infection.ICU length of stay,laparotomy and SOFA score are risk factors for CRE colonization and infection,clinical management of these patients should be strengthened.The mechanism of CRE resistance can provide direction for treatment,and tigecycline is currently the main drug against CRE.