与CRKP感染/定植患者人住同一房间增加感染风险—基于ICU的病例对照研究
Increasing risk of infection in patients staying in the same room with CRKP infection/colonization:a case-control study bused on ICU
黄文治 1乔甫 2朱仕超 2李婧闻 2邓宇骅 2宗志勇 3张伟4
作者信息
- 1. 四川大学华西医院感染性疾病中心,四川成都 610000;四川大学华西医院医院感染管理部,四川成都 610000
- 2. 四川大学华西医院医院感染管理部,四川成都 610000
- 3. 四川大学华西医院感染性疾病中心,四川成都 610000
- 4. 四川大学医学院,四川成都 610000
- 折叠
摘要
目的 研究与耐碳青霉烯肺炎克雷伯菌(CRKP)感染/定植患者同住一房间是否增加其感染风险.方法 于2016年1月-2018年12月于四川大学华西医院ICU病房开展病例-病例对照研究;包括两个病例对照研究,研究1的病例组为CRKP医院感染患者,对照组为未检出CRKP的患者;研究2的病例组为碳青霉烯敏感的肺炎克雷伯菌(CSKP)医院感染患者,对照组为未检出CRKP及CSKP的患者;采用二元Logistic回归分别对CRKP和CSKP两个病例组分析其影响因素.结果 共纳入2 269名患者作为研究对象,其中研究1的病例组为106例,研究2的病例组为52例;同一房间暴露是CRKP医院感染的危险因素(OR=2.037,95％CJ:1.277～3.251,P=0.003);肺炎克雷伯菌对碳青霉烯耐药的其他危险因素包括急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分(OR=1.029,95％CI:1.001～1.057,P=0.042)、替加环素(OR=1.944,95％CI:1.245～3.034,P=0.003)、肠外营养(OR=1.998,95％CI:1.052～3.792,P=0.034)、肠道定植(OR=4.160,95％CI:2.702～6.407,P＜0.001)、胰腺炎(OR=1.807,95％CI:1.125～2.902,P=0.014)及雾化吸入(OR=2.082,95％CI:1.232～3.520,P=0.006).结论 同一房间暴露是CRKP医院感染的危险因素,对可防可控的危险因素应制定具体管理措施及策略,以更有针对性、更科学有效地开展ICU病房的CRKP医院感染防控工作.
Abstract
OBJECTIVE To study whether staying in the same room with carbapenem resistant Klebsiella pneu-moniae(CRKP)infected/colonized patients increase the risk of infection in ICU.METHODS A case-case-control study was conducted in the ICU ward of West Hospital of Sichuan university from Jan.2016 to Dec.2018.Two Case-control studies were included,the case group of study 1 was patients with hospital-acquired infections of CRKP,and the control group was patients without CRKP.The case group of study 2 was patients with hospital-acquired infections of carbapenem sensitive Klebsiella pneumoniae(CSKP),and the control group was the pa-tients without CRKP and CSKP.Binary logistic regression was used to analyze the influencing factors of the two case groups for CRKP and CSKP respectively.RESULTS A total of 2 269 patients were included as study subjects,with 106 cases in the case group of study 1 and 52 cases in the case group of study 2.Same-room exposure was an independent risk factor for CRKP hospital-acquired infections(OR=2.037,95％CI 1.277-3.251,P=0.003);Other independent risk factors for carbapenem resistance in Klebsiella pneumoniae included APACHE Ⅱ score(OR=1.029,95％CI:1.001-1.057,P=0.042),tigecycline(OR=1.944,95％CI 1.245-3.034,P=0.003),parenteral nutrition(OR=1.998,95％CI:1.052-3.792,P=0.034),intestinal colonization(OR=4.160,95％CI 2.702-6.407,P＜0.001),pancreatitis(OR=1.807,95％CI 1.125-2.902,P=0.014)and nebulization(OR=2.082,95％CI 1.232-3.520,P=0.006).CONCLUSION The same-room exposure was an independent risk factor for CRKP hospital-acquired infections,and specific management measures and strategies should be for-mulated for preventable and controllable risk factors in order to carry out the prevention and control of CRKP in a more targeted,scientific and effective manner.
关键词
耐碳青霉烯肺炎克雷伯菌/病例对照研究/同一房间暴露/危险因素/感染/定植/ICUKey words
Carbapenem-resistant Klebsiella pneumoniae/Case-control study/Same-room exposure/Risk factor/Infection/Colonization/ICU引用本文复制引用
基金项目
四川省科技厅软科学基金资助项目(2017ZR0170)
四川省预防医学会医院感染预防与控制基金资助项目(SCGK201806)
出版年
2024
NETL
NSTL
万方数据