Abstract：
OBJECTIVE: Severe infection caused by Carbapenem-resistant Enterobacteriaceae (CRE) is a challenge for clinical anti-infective therapy, and clinical intervention to improve control of CRE is of great significance. The study aims to determine the molecular epidemiology and risk factors of CRE infections to provide evidence for effective control of nosocomial infection in patients with CRE.
METHODS: A total of 192 non-repetitive CRE strains were collected from January 2020 to December 2021 in Northwest China. To explore the risk factors of CRE infection by univariate and Logistic regression analysis, 1:1 case-control study was used to select Carbapenem sensitive Enterobacteriaceae (CSE) infection patients at the same period as the control group.
RESULTS: Among the 192 CRE strains, the most common isolates included Klebsiella pneumoniae (Kpn) and Enterobacter cloacae (Ecl). The CRE strain showed the lowest rate of resistance to amikacin at 58.3. 185 CRE strains carried carbapenemase resistance genes of concern in this study. KPC-2 (n=94) was the most common carbapenemase, followed by NDM-1 (n=69), NDM-5 (n=22) and IMP-4 (n=5). OXA-48 and VIM were not detected. And KPC-2 was the most common in all strains. Logistic regression analysis implicated days of invasive ventilator-assisted ventilation (OR=1.452; 95 % CI 1.250～1.686), antibiotic combination therapy (OR=2.149; 95 % CI 1.128～4.094), hypoalbuminemia (OR=6.137; 95 % CI 3.161～11.913), history of immunosuppressant use (OR=25.815; 95 % CI 6.821～97.706) and days of hospitalization (OR=1.020; 95 % CI 1.006～1.035) as independent risk factors associated with CRE infection. Age (OR=0.963; 95% CI 0.943～0.984) and history of hormone use (OR=0.119; 95 % CI 0.028～0.504) were protective factors for CRE infection (P < 0.05).
CONCLUSIONS: The resistance of commonly used antibiotics in clinical is severe, and CRE strains mainly carry KPC-2 and NDM-1. Multiple risk factors for CRE infection and their control can effectively prevent the spread of CRE.
METHODS: A total of 192 non-repetitive CRE strains were collected from January 2020 to December 2021 in Northwest China. To explore the risk factors of CRE infection by univariate and Logistic regression analysis, 1:1 case-control study was used to select Carbapenem sensitive Enterobacteriaceae (CSE) infection patients at the same period as the control group.
RESULTS: Among the 192 CRE strains, the most common isolates included Klebsiella pneumoniae (Kpn) and Enterobacter cloacae (Ecl). The CRE strain showed the lowest rate of resistance to amikacin at 58.3. 185 CRE strains carried carbapenemase resistance genes of concern in this study. KPC-2 (n=94) was the most common carbapenemase, followed by NDM-1 (n=69), NDM-5 (n=22) and IMP-4 (n=5). OXA-48 and VIM were not detected. And KPC-2 was the most common in all strains. Logistic regression analysis implicated days of invasive ventilator-assisted ventilation (OR=1.452; 95 % CI 1.250～1.686), antibiotic combination therapy (OR=2.149; 95 % CI 1.128～4.094), hypoalbuminemia (OR=6.137; 95 % CI 3.161～11.913), history of immunosuppressant use (OR=25.815; 95 % CI 6.821～97.706) and days of hospitalization (OR=1.020; 95 % CI 1.006～1.035) as independent risk factors associated with CRE infection. Age (OR=0.963; 95% CI 0.943～0.984) and history of hormone use (OR=0.119; 95 % CI 0.028～0.504) were protective factors for CRE infection (P < 0.05).
CONCLUSIONS: The resistance of commonly used antibiotics in clinical is severe, and CRE strains mainly carry KPC-2 and NDM-1. Multiple risk factors for CRE infection and their control can effectively prevent the spread of CRE.
摘要：
目的：耐碳青霉烯类肠杆菌（CRE）引起的严重感染是临床抗感染治疗的挑战，临床干预对提高CRE的控制具有重要意义。本研究旨在确定CRE感染的分子流行病学和危险因素，为有效控制CRE患者医院感染提供依据。
方法：从2020年1月至2021年12月在中国西北地区收集了192株非重复CRE菌株。通过单因素和Logistic回归分析探讨CRE感染的危险因素。采用1:1病例对照研究选择同期碳青霉烯类敏感肠杆菌科(CSE)感染患者作为对照组。
结果：在192个CRE菌株中，最常见的分离株包括肺炎克雷伯菌(Kpn)和阴沟肠杆菌(Ecl).CRE菌株对阿米卡星的耐药率最低，为58.3。在这项研究中，185个CRE菌株携带了碳青霉烯酶抗性基因。KPC-2(n=94)是最常见的碳青霉烯酶,其次是NDM-1(n=69)，NDM-5(n=22)和IMP-4(n=5)。未检测到OXA-48和VIM。KPC-2在所有菌株中最常见。Logistic回归分析提示有创呼吸机辅助通气天数(OR=1.452;95%CI1.250～1.686),抗生素联合治疗（OR=2.149；95%CI1.128~4.094），低蛋白血症（OR=6.137；95％CI3.161〜11.913），免疫抑制剂使用史（OR=25.815；95％CI6.821〜97.706）和住院天数（OR=1.020；95％CI1.006〜1.035）是与CRE感染相关的独立危险因素。年龄（OR=0.963；95％CI0.943〜0.984）和激素使用史（OR=0.119；95％CI0.028〜0.504）是CRE感染的保护因素（P<0.05）。
结论：临床常用抗菌药物耐药严重，CRE菌株主要携带KPC-2和NDM-1。CRE感染的多重危险因素及其控制可有效预防CRE的传播。
方法：从2020年1月至2021年12月在中国西北地区收集了192株非重复CRE菌株。通过单因素和Logistic回归分析探讨CRE感染的危险因素。采用1:1病例对照研究选择同期碳青霉烯类敏感肠杆菌科(CSE)感染患者作为对照组。
结果：在192个CRE菌株中，最常见的分离株包括肺炎克雷伯菌(Kpn)和阴沟肠杆菌(Ecl).CRE菌株对阿米卡星的耐药率最低，为58.3。在这项研究中，185个CRE菌株携带了碳青霉烯酶抗性基因。KPC-2(n=94)是最常见的碳青霉烯酶,其次是NDM-1(n=69)，NDM-5(n=22)和IMP-4(n=5)。未检测到OXA-48和VIM。KPC-2在所有菌株中最常见。Logistic回归分析提示有创呼吸机辅助通气天数(OR=1.452;95%CI1.250～1.686),抗生素联合治疗（OR=2.149；95%CI1.128~4.094），低蛋白血症（OR=6.137；95％CI3.161〜11.913），免疫抑制剂使用史（OR=25.815；95％CI6.821〜97.706）和住院天数（OR=1.020；95％CI1.006〜1.035）是与CRE感染相关的独立危险因素。年龄（OR=0.963；95％CI0.943〜0.984）和激素使用史（OR=0.119；95％CI0.028〜0.504）是CRE感染的保护因素（P<0.05）。
结论：临床常用抗菌药物耐药严重，CRE菌株主要携带KPC-2和NDM-1。CRE感染的多重危险因素及其控制可有效预防CRE的传播。
