ICUにおけるCRE感染のリスクファクターに関する症例対照研究

Introduction: In recent years, the increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) poses a serious threat to clinical anti-infection therapy. This study aims to identify risk factors for CRE infection among intensive care unit (ICU) patients.

Methodology: An unmatched case-control study based on a hospital was performed. Data on the general condition of patients, disease scores, invasive procedures, and the use of antibiotics before infection were collected. Univariate and multivariate Logistic regression were performed to analyze the risk factors for CRE infection.

Results: The univariate analysis results indicated that higher APACHE-II scores, tracheal intubation, urinary catheterization, gastric tube insertion, prior use of antibiotics, use of three or more types of antibiotics, and the use of carbapenems, broad-spectrum penicillins, antifungals, and aminoglycosides were potential risk factors for CRE infection in ICU patients. In contrast, a higher GCS score appeared to be a potential protective factor against CRE infection in ICU patients. Multivariate Logistic regression analysis showed that higher APACHE-II score (OR=2.425, 95% CI:1.713~3.946), tracheal intubation (OR=3.459, 95% CI:2.617~7.148), and the use of antibiotics before infection (OR=2.704, 95% CI: 2.013~5.358) were the risk factors of CRE infection in ICU patients; higher GCS score (OR=0.459, 95% CI: 0.349~0.725) was the protective factors of CRE infection in ICU patients.

Conclusion: Multiple risk factors for CRE infections in ICU patients are closely related to patients' clinical conditions and treatment regimens. Clinically, it is essential to regularly screen ICU patients with high-risk factors for CRE infections, enhance antimicrobial stewardship, perform pathogen cultures and identification, and minimize invasive procedures. These measures are critical for preventing and reducing CRE infections.