产碳青霉烯酶肠杆菌目细菌感染临床特征、耐药性及预后:一项前瞻性单中心研究OA

Objective To detect carbapenemase types in strains isolated from patients with carbapenem-resistant Enterobacterales(CRE)infection,analyze bacterial resistance,clinical characteristics of infected patients,and related factors affecting patients'prognosis.Methods Non-repetitive CRE strains isolated from adult inpatients in a secondary first-class general hospital from 2023 to 2024 were collected prospectively.Carbapenemase types were detected,patients'clinical data were investigated,and factors affecting the clinical treatment outcome of patients with carbapenemase-procucing Enterobacterales(CPE)infection were analyzed with univariate and multivariate regression models.Results Clinical data of 151 CRE infected patients were collected,the detection of carbapenem-resistant Klebsiella pneumoniae(CRKP)took the highest proportion(n=134,88.7％).All of the 151 CRE strains contained carbapenemase,including 111 strains(73.5％)containing only class A serine carbapenemase(all KPC type),32 strains(21.2％)containing only class B metallo-β-lactamase(MBL),and 8 strains(5.3％)contai-ning both KPC and MBL(double-carbapenemase-producing,DCP).KPC represented the main form in CRKP(82.1％).Both carbapenem-resistant Escherichia coli(CREC)and carbapenem-resistant Enterobacter cloacae(CRECL)produced MBL.The resistance rates of 151 CPE strains to ampicillin/sulbactam,piperacillin/tazobac-tam,cefoperazone/sulbactam,and ticarcillin/clavulanic acid were all over 90％.The resistance rates to ceftazidime/avibactam in only-MBL-producing strains and DCP strains were higher than those in only-KPC-producing strains(both P<0.05).The resistance rates of only-KPC-producing and DCP strains to aminoglycosides,doxycycline,and compound sulfamethoxazole were higher than those of only-MBL-producing strains(all P<0.05).All three types of CPE strains had good sensitivity to polymyxin B,with a resistance rate of 0-4.2％.The resistance rates of KPC-and MBL-producing strains to tigecycline were low(0-4.2％),while the resistance rate of DCP strains to tigecycline was 100％.27.2％(n=41)of patients died within 30 days after infection.Multivariate regression analysis showed that healthcare-associated infection(HAI)(OR=12.88,95％CI:4.15-39.96),indwelling gastric tube(OR=10.51,95％CI:2.19-50.45),and high abdominal blood glucose level during infection(OR=1.24,95％CI:1.08-1.41)were all independent risk factors for death within 30 days after infection in patients with CPE infection,while high serum albumin level during infection(OR=0.80,95％CI:0.70-0.90)was an inde-pendent protective factor.Conclusion The prevalence of CPE in secondary general hospitals is high,and antimicro-bial resistance is severe,especially in the cases of KPC-producing and DCP strains showing wider spectrum of anti-microbial resistance.Attention should be paid to CRE screening and enzyme type monitoring to prevent HAI.High-risk populations should also be paid attention to improve clinical prognosis.