摘要
目的分析重症监护病房(intensive care unit,ICU)内耐碳青霉烯类肠杆菌(carbapenem⁃resis⁃tant Enterobacteriaceae,CRE)的定植情况及感染危险因素,探讨定植情况对感染率的影响及预测价值。方法回顾分析2016年4月至2017年12月间北京大学人民医院ICU收治的所有患者资料。根据患者是否感染CRE分为CRE感染组和非CRE感染组。收集患者基本特征、基础疾病、入ICU时CRE定植情况、其他感染相关指标及治疗评价指标等资料。Logistic回归分析CRE感染的危险因素;采用受试者工作特征曲线(ROC)评价入ICU时定植阳性对患者发生ICU内CRE感染的预测价值。结果本研究共纳入研究对象3211例,接受主动筛查的高危患者共2163例。高危患者发生CRE感染者共54例,感染患者CRE定植率显著高于非感染患者(22.0%vs.11.5%,P<0.05)。多因素分析结果显示,入ICU时CRE定植阳性,急性生理和慢性健康评分II(APACHE II)高,以及接受碳青霉烯类、三或四代头孢菌素类和氟喹诺酮类抗生素治疗>3 d是CRE感染的独立危险因素。ROC曲线分析显示,CRE定植阳性预测患者发生感染的曲线下面积为0.684;CRE定植阳性联合应用抗生素治疗因素的曲线下面积为0.765。结论CRE定植阳性是ICU患者发生CRE感染的高危因素,且对感染的发生有一定的预测价值。
Objective To assess the value of carbapenem⁃resistant Enterobacteriaceae(CRE)for predict⁃ing infection of patients in intensive care unit.Methods The clinical data of all patients admitted in the ICU of our hospital from April 2016 to December 2017 were analysed.Patients were divided into CRE infection group and non⁃CRE infection group.The general clinical data,previous history,acute physiology and chronic health evalua⁃tion(APACHE)Ⅱscore,mechanical time and infection related indexes were compared between the groups.Risk factors of CRE infection were studied by multivariable regression analysis;predictive value of CRE colonization for infection was assessed by receiver operating curve(ROC).Results A total of 3211 patients were included,2163 were considered to be at high risk of CRE infection and were screened for CRE colonization.Compared with non⁃CRE infection group(n=2113),CRE infection patients(n=50)had the higher CRE colonization rate(22.0%vs.11.5%,P<0.05).Logistic regression showed that independent risk factors of CRE infection were CRE coloniza⁃tion,APACHEⅡscore and prior antimicrobial use.AUC of ROC for predictive value of CRE colonization in infec⁃tion was 0.684;combination AUC of CRE colonization and prior antimicrobial use was 0.765.Conclusions CRE colonization was independent risk factor of CRE infection.CRE colonization had predictive value for infection in this patient cohort.
作者
李纾
郭辅政
赵秀娟
安友仲
朱凤雪
LI Shu;GUO Fuzheng;ZHAO Xiujuan;AN Youzhong;ZHU Fengxue(Department of Critical Care Medicine,Trauma Centre,Peking University People′s Hospital,Beijing 100044,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第2期254-257,共4页
The Journal of Practical Medicine
基金
首都卫生发展科研专项项目(编号：首发2018-2-4082)
关键词
耐碳青霉烯类肠杆菌
定植
重症监护病房
高危因素
carbapenem⁃resistant Enterobacteriaceae
colonization
intensive care unit
risk factors
