合肥地区某三级医院碳青霉烯耐药肺炎克雷伯菌血流感染危险因素分析

合肥地区某三级医院碳青霉烯耐药肺炎克雷伯菌血流感染危险因素分析摘要

目的：本研究旨在分析合肥地区某三级医院碳青霉烯耐药肺炎克雷伯菌血流感染的危险因素，为临床医生提供指导。

方法：回顾性分析2017年1月至2020年12月间碳青霉烯耐药肺炎克雷伯菌血流感染的患者资料，采用单因素与多因素Logistic回归分析，多因素分析包括性别、年龄、基础疾病、留置导管、呼吸机使用等因素。

结果：共纳入261例患者，其中男性157例（60.2%），女性104例（39.8%）。单因素Logistic回归分析显示，留置导管、呼吸机使用、消化道功能损伤、胆囊疾病、输血等因素是血流感染的危险因素（P<0.05）；多因素Logistic回归分析显示，留置导管、呼吸机使用是血流感染的独立危险因素（P<0.05）。

结论：留置导管和呼吸机使用是该医院碳青霉烯耐药肺炎克雷伯菌血流感染的独立危险因素，应采取针对性措施，降低血流感染率。

关键词：碳青霉烯耐药肺炎克雷伯菌，血流感染，留置导管，呼吸机使用，多因素分析

Abstract

Objective:Thisstudyaimedtoanalyzetheriskfactorsofcarbapenem-resistantKlebsiellapneumoniaebloodstreaminfectionsinatertiaryhospitalinHefei,providingguidanceforclinicians.

Methods:Weretrospectivelyanalyzedthedataofpatientswithcarbapenem-resistantKlebsiellapneumoniaebloodstreaminfectionsbetweenJanuary2017andDecember2020.Univariateandmultivariatelogisticregressionanalysiswereperformed,andthemultivariateanalysisincludedfactorssuchasgender,age,underlyingdiseases,indwellingcatheter,andmechanicalventilation.

Results:Atotalof261patientswereincluded,including157males(60.2%)and104females(39.8%).Univariatelogisticregressionanalysisshowedthatindwellingcatheter,mechanicalventilation,digestivefunctioninjury,gallbladderdisease,transfusion,andotherfactorswereriskfactorsforbloodstreaminfections(P<0.05).Multivariatelogisticregressionanalysisshowedthatindwellingcatheterandmechanicalventilationwereindependentriskfactorsforbloodstreaminfections(P<0.05).

Conclusion:Indwellingcatheterandmechanicalventilationareindependentriskfactorsforcarbapenem-resistantKlebsiellapneumoniaebloodstreaminfectionsinthishospital.Targetedmeasuresshouldbetakentoreducetherateofbloodstreaminfections.

Keywords:Carbapenem-resistantKlebsiellapneumoniae,bloodstreaminfection,indwellingcatheter,mechanicalventilation,multivariateanalysiCarbapenem-resistantKlebsiellapneumoniae(CRKP)bloodstreaminfectionsareasignificantconcerninhospitalsworldwide,anditisessentialtoidentifyriskfactorsthatcontributetotheprevalenceoftheseinfections.ThisstudyaimedtodeterminetheriskfactorsforCRKPbloodstreaminfectionsinahospitalinChina.

Thestudyfoundthattwoparticularriskfactors,indwellingcathetersandmechanicalventilation,wereindependentfactorsthatcontributedtobloodstreaminfections.Thesefindingsemphasizetheimportanceofreducingtheuseofindwellingcathetersandimprovingthemanagementofmechanicalventilationinhospitalsettings.Inaddition,targetedmeasuresshouldbetakentoreducebloodstreaminfections,suchasimprovinginfectioncontrolpracticesandincreasingawarenessamonghealthcareworkers.

TheresultsofthisstudyhighlighttheneedforongoingmonitoringofinfectionratesandtheimplementationoftargetedinterventionstoreducetheprevalenceofCRKPbloodstreaminfections.Byidentifyingandaddressingriskfactors,healthcareproviderscanmitigatetheadverseeffectsoftheseinfectionsonpatientoutcomesandreducetheburdenofhealthcare-associatedinfections.Itiscrucialtoremainvigilantandimplementevidence-basedpracticestopreventandcontrolthespreadofCRKPInadditiontomonitoringandinterventions,thereareseveralotherstrategiesthatcanbeemployedtoreducetheprevalenceofCRKPbloodstreaminfections.Onesuchstrategyisantimicrobialstewardship,whichinvolvesoptimizingtheuseofantibioticstoreducethedevelopmentandspreadofantibiotic-resistantorganisms.Thiscanbeachievedthroughtheimplementationofantibioticguidelinesandprotocols,aswellasthrougheducationandtrainingofhealthcareproviders.

Anotherstrategyisinfectioncontrol,whichinvolvespreventingthespreadofinfectionswithinhealthcarefacilities.Thiscanbeachievedthroughtheuseofstandardprecautions,suchashandhygiene,personalprotectiveequipment,andenvironmentalcleaning,aswellasthroughtargetedinterventions,suchasscreeningandisolationofpatientswithCRKP.

EducationandawarenesscampaignscanalsoplayanimportantroleinreducingtheprevalenceofCRKPbloodstreaminfections.Byeducatinghealthcareprovidersandpatientsabouttherisksandconsequencesofantibioticresistance,aswellasaboutstrategiesforpreventionandcontrol,awarenesscanberaisedandbehaviorcanbechanged.

Finally,researchintonewtreatmentsforCRKPinfectionsisessentialinordertoprovideeffectiveoptionsforpatientswhododeveloptheseinfections.Thisincludesthedevelopmentofnewantibiotics,aswellasalternativetreatmentmodalities,suchasphagetherapyandimmunotherapy.

Inconclusion,CRKPbloodstreaminfectionsposeasignificantthreattopatientoutcomesandhealthcare-associatedinfections.Ongoingmonitoring,targetedinterventions,andtheimplementationofevidence-basedstrategiesareessentialtoreducingtheprevalenceoftheseinfectionsandmitigatingtheiradverseeffects.Byworkingtogether,healthcareproviders,researchers,andpolicymakerscancontinuetoadvanceeffortstopreventandcontrolthespreadofCRKPandotherantibiotic-resistantorganismsInadditiontothemeasuresdiscussedabove,itiscrucialtoemphasizeeducationandawarenessamonghealthcareworkersandpatientsalikeregardingtheproperuseofantibioticsandhandhygienepractices.Overuseandmisuseofantibioticscanleadtotheemergenceandspreadofantibiotic-resistantorganisms,whichcanbeespeciallychallenginginthecaseofbloodstreaminfections.Robustantimicrobialstewardshipprogramsandinfectionpreventionandcontrolprotocolsneedtobeinplacetocombatthegrowingthreatofantibioticresistanceinhealthcaresettings.

Furthermore,researchintonewantibioticsandalternativeantimicrobialtreatmentsisimperative,asthedevelopmentofnewdrugshasnotkeptpacewiththeemergenceofantibiotic-resistantorganisms.Collaborationsbetweenresearchers,pharmaceuticalcompanies,andgovernmentagenciesarenecessarytoacceleratethediscoveryanddevelopmentofnewantibioticsandotherinnovativetherapies.

Finally,acoordinatedglobalapproachisneededtoaddressthisissue,asantibioticresistanceknowsnogeographicalorpoliticalboundaries.Internationalcollaborations,regulations,andguidelinescanhelptoensurethatantibioticuseisoptimized,infectionpreventionandcontrolmeasuresarereinforced,andthespreadofantibiotic-resistantorganismsiscontrolled.

Inconclusion,bloodstreaminfectionscausedbyantibiotic-resistantorganisms,suchasCRKP,poseasignificantthreattopatientoutcomesandhealthcare-associatedinfections.Targetedinterventions,ongoingmonitoring,andtheimplementationofevidence-basedstrategiesareessentialtoreducingtheprevalenceoftheseinfectionsandmitigatingtheiradverseeffects.Byworkingtogether,healthcareproviders,