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中华重症医学电子杂志

中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (02) : 178 -184. doi: 10.3877/cma.j.issn.2096-1537.2023.02.008

临床研究

西宁地区某三甲医院ICU 耐碳青霉烯类肠杆菌主动筛查与感染的单中心研究
蒋辛, 潘纯, 黄文辉, 甘桂芬†()   
  1. 810000 西宁，青海大学附属医院重症医学科
    210009 南京，江苏省重症医学重点实验室　东南大学附属中大医院重症医学科
    810000 西宁，青海大学附属医院检验科
  • 收稿日期:2022-04-15 出版日期:2023-05-28
  • 通信作者: 甘桂芬
  • 基金资助:
    青海省重症肺炎救治技术集成应用项目(2019-SF-133)

A study on active CRE screening and CRE infection in anal swabs in Intensive Care Units in Qinghai area

Xin Jiang, Chun Pan, Wenhui Huang, Guifen Gan†()   

  1. Department of Critical Care Medicine, Affiliated Hospital of Qinghai University, Xining 810000, China
    Jiangsu Provincial Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
    Department of Laboratory Medicine, Affiliated Hospital of Qinghai University, Xining 810000, China
  • Received:2022-04-15 Published:2023-05-28
  • Corresponding author: Guifen Gan
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引用本文：

蒋辛, 潘纯, 黄文辉, 甘桂芬. 西宁地区某三甲医院ICU 耐碳青霉烯类肠杆菌主动筛查与感染的单中心研究[J]. 中华重症医学电子杂志, 2023, 09(02): 178-184.

Xin Jiang, Chun Pan, Wenhui Huang, Guifen Gan. A study on active CRE screening and CRE infection in anal swabs in Intensive Care Units in Qinghai area[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 178-184.

目的

分析青海大学附属医院ICU耐碳青霉烯类肠杆菌（CRE）的定植及感染现状，评估CRE定植对CRE感染的影响，为医院CRE感染的预防和控制提供科学依据。

方法

采用前瞻性、观察性研究方法，对2020年12月至2021年12月期间入住青海大学附属医院ICU并满足纳入及排除标准的患者进行肛拭子CRE主动筛查，收集患者CRE主动筛查结果及CRE感染情况。

结果

本研究共筛查296例患者，18例患者CRE定植阳性，定植率为6.08%（18/296）。研究期间共有6例患者发生CRE感染，感染率为2.03%（6/296），CRE感染患者中有4例CRE定植阳性，CRE感染患者的定植率为66.67%（4/6），非CRE感染患者的定植率为4.83%（14/290）。CRE定植与CRE感染存在一致性（Kappa=0.312，P＝0.000）。6例CRE感染患者有4例死亡，CRE感染的病死率为66.67%（4/6）。CRE定植菌株以大肠埃希菌为主，酶型主要为新德里金属β-内酰胺酶（NDM）型。CRE感染菌株以肺炎克雷伯菌为主，酶型主要为NDM型。

结论

CRE定植患者具有更高的CRE感染风险，对ICU CRE感染的高危人群进行肛拭子主动筛查可及早发现CRE定植菌株的存在，有利于CRE感染的预防控制。

关键词: ICU, 耐碳青霉烯肠杆菌, 主动筛查, 定植, 感染
Objective

To analyze the current status of Carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection in ICU of Qinghai University Affiliated Hospital, and to evaluate the impact of CRE colonization on CRE infection.

Methods

A prospective study was performed. Patients who were admitted to the ICU of Qinghai University Affiliated Hospital and met the inclusion and exclusion criteria from December 2020 to December 2021 were actively screened for CRE with anal swabs. The results of active CRE screening and CRE infection were collected.

Results

A total of 296 patients were included in this study, and 18 patients were positive for CRE colonization, with a colonization rate of 6.08% (18/296). During the study period, a total of 6 patients developed CRE infection, with a rate of 2.03% (6/296). Four patients with CRE infection had a positive results of CRE colonization, with a colonization rate of 66.67% (4/6). By contrast, the colonization rate in non-CRE infected patients was 4.83% (14/290). CRE colonization had a consistent relationship with CRE infection (Kappa=0.312, P=0.000). Four of 6 patients with CRE infection died, with mortality rate of 66.67% (4/6). The CRE colonization strains were mainly Escherichia coli with mainly NDM type. Klebsiella pneumoniae was the main strain of CRE infection with a mainly NDM type.

Conclusion

CRE colonized patients have a higher risk of CRE infection. Active anal swab screening for high-risk patient is helpful to detect CRE colonized strains early, which is beneficial to the prevention and control of CRE infection.

Key words: Intensive care unit, Active screening, Carbapenem-resistant Enterobacteriaceae, Colonization, Infection
表1 CRE定植阳性患者及CRE感染患者来源分布情况
患者来源 CRE筛查阳性 CRE感染
例数 百分比（%） 例数 百分比（%）
外院转入 7 38.89 3 50.00
脑外科 1 5.56 0 0
肝胆外科 1 5.56 1 16.67
口腔外科 3 16.67 0 0
心内科 1 5.56 0 0
神经内科 0 0 1 16.67
急诊外科 1 5.56 0 0
急诊内科 1 5.56 0 0
消化科 1 5.56 0 0
肾病内科 1 5.56 1 16.67
介入科 1 5.56 0 0
合计 18 100.0 6 100.0
表2 CRE感染与肛拭子CRE检出结果交叉表
CRE感染 肛拭子筛查结果 合计
阳性 阴性
是 4 2 6
否 14 276 290
合计 18 278 296
表3 肛拭子CRE主动筛查菌株及酶型检出情况
病原体 例数 构成比（%） 主要酶型 例数 构成比（%）
大肠埃希菌 12 63.15 NDM 12 63.15
肺炎克雷伯菌 5 26.32 NDM 4 21.05
KPC 1 5.26
阴沟肠杆菌 2 10.53 NDM 2 10.53
表4 6例CRE感染患者一般情况统计
患者编号 性别 年龄（岁） 患者来源 主要诊断 住院时间（d） ICU住院时间（h） 既往病史 是否多次住院 此次腹部手术 CRE感染情况 CRE定植情况
标本来源 检出菌株 检出酶型 感染前抗生素使用情况 菌株 酶型 预后
1 男 58 外院转入 脑出血 57 1370 糖尿病、高血压 是 否 血液 Kpn NDM型 莫西沙星、替加环素、比阿培南 Kpn NDM型 死亡
2 女 67 肝胆转入 胆管癌 82 160 尿失禁 是 剖腹探查 血液、腹腔引流液 Eco NDM型 头孢他啶、亚胺培南 Eco NDM型 转肝胆外
3 女 61 外院转入 弥漫性腹膜炎 23 549 无 是 剖腹探查 腹水/腹腔冲洗液 Ecl NDM型 头孢他啶 Ecl NDM型 出院
4 女 48 肾内科转入 SLE 26 166 房间隔缺损 是 否 血液 Kpn KPC型 头孢哌酮钠/舒巴坦钠、莫西沙星 Kpn KPC型 死亡
5 男 86 神内科转入 脑梗死 29 695 高血压 否 否 支气管肺泡灌洗液 Kpn NDM型 头孢呋辛、头孢哌酮钠/舒巴坦钠、替加环素 - - 死亡
6 男 72 外院转入 弥漫性腹膜炎 79 1892 高血压 否 开腹手术 腹腔引流液 Ecl NDM型 头孢哌酮钠/舒巴坦钠、替加环素、比阿培南 - - 死亡
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