由于耐卡巴胺的肠道细菌引起的血液感染的危险因素:一个嵌套病例控制控制研究
Hongyu Zhou1,2, Niccolò Buetti1,3, Salvador Pérez-Galera4,5
1Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
The Journal of antimicrobial chemotherapy
|July 11, 2024
概括
之前的耐卡巴胺肠道细菌 (CRE) 殖民显著增加了CRE血流感染 (BSI) 的风险. 医疗保健暴露和先前的多耐药生物体 (MDRO) 感染是患者中CRE BSI的关键风险因素.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 流行病学 流行病学
背景情况:
- 耐卡巴胺的肠细菌 (CRE) 血流感染 (BSI) 对患者的健康构成重大威胁.
- 关于CRE BSI风险因素的现有数据在内部和外部有效性方面存在限制.
- 这项研究旨在使用强大的多中心病例控制控制设计来确定CRE BSI的风险因素.
研究的目的:
- 确定与耐卡巴胺肠道细菌 (CRE) 血流感染 (BSI) 相关的危险因素.
- 为了比较患有CRE BSI和患有卡巴尼姆敏感肠道细菌 (CSE) BSI的患者之间的风险因素.
- 通过与未感染的患者进行比较来确定CRE BSI的风险因素.
主要方法:
- 一个多中心,病例控制和控制研究,嵌入在欧洲前性队列研究中对CRE (EURECA).
- 根据医院,病房和停留时间,CRE BSI病例与CSE BSI病例 (1:1) 和未感染的对照 (1:3) 的匹配.
- 使用条件后勤回归分析来确定独立的风险因素.
主要成果:
- 与CSE BSI相比,以前的CRE殖民或感染是CRE BSI (IRR 7.32) 的一个显著的风险因素.
- 对于CRE BSI与未感染的对照组,独立的风险因素包括年龄较大,患者转诊 (LTCF/ACH),先前的MDRO殖民/感染 (IRR 9.71),血液透析,侵入性手术和接触特定抗生素.
- 在入学前3个月内接触抗生素,包括β-乳酸/β-乳酸酶抑制剂组合 (IRR 3.92) 和第三/第四代头素 (IRR 2.75),增加了CRE BSI风险.
结论:
- 上一篇 CRE殖民/感染是发展 CRE BSI 的主要风险因素.
- 医疗保健暴露,包括先前的MDRO殖民/感染和特定的抗生素使用,是CRE BSI的关键风险因素.
- 建议针对高风险患者群体进行有针对性的查,加强感染预防策略和明智的抗菌药物管理.
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