Active Screening Study Of CRE In ICU And Related Wards

ObjectiveThe growing issue of bacterial resistance has become a focus in global public health.As a member of drug resistant bacteria,carbapenem-resistant Enterobacteriaceae(CRE)poses a grave challenge to clinical anti-infection therapy due to its highly epidemic,antibiotic resistance,and mortality.The intensive care unit(ICU),as an admission unit for critically ill patients,has a large scale of susceptible people with underlying diseases and low immunity and is a high-risk area for CRE colonization and infection.CRE colonization,which mostly occurs in the human intestinal tract,is a risk factor for the development of infection.Also,CRE-infected patients can develop CRE intestinal colonization.the relationship between CRE colonization and CRE infection and their specific mechanisms is still being explored.In this article,we explore the basic characteristics,risk factors,antibiotic therapy,prognosis,and the relationship between patients with CRE colonization and patients with CRE infection in ICU within 1 year,so as to provide the basis for clinical prevention and management.Methods1.848 Anal swab specimens were collected from 269 patients first hospitalized in the Department of Intensive Care Medicine,The First Affiliated Hospital of Dalian Medical University from July 1,2021 to September 1,2022,the carbapenemase phenotype was detected by colloidal gold immunochromatography after the pure strains were cultured,so as to clarify the drug resistance gene.2.Sputum and other samples were collected and sent to the microbiological laboratory for pathogenic culture,after the pure infection strains were divided,drug sensitivity tests and identification of pathogenic bacteria were performed using the VITEK-2compact fully automated microbial identification and drug sensitivity analysis system.3.We reviewed the relevant literature to understand the risk factors for CRE colonization and infection,and included the cases of non-CRE intestinal colonization and the non-CRE infected group in the control group,the cases of CRE intestinal colonization and the CRE infected group was included in the experimental group.Clinical data,including age,gender,patient origin,previous 3-month hospitalization history,underlying disease,primary disease,invasive procedure,APACHEⅡ score and SOFA score,antimicrobial therapy [whether antibiotics were used,types of antibiotics used,whether polymyxin was used within 14 days,whether meropenem or tigecycline or polymyxin was used after CRE infection],days of hospitalization in ICU,and discharge situation,were collected separately from the two control and experimental groups.SPSS25.0 software was used to perform univariate and multifactorial statistical analysis of clinical data in the two pairs of study subjects,and statistical significance was defined as P < 0.05.Results1.There were 131 patients with CRE intestinal colonization in ICU,with an intestinal colonization rate of 48.70%(131/269),with Klebsiella pneumoniae as the main colonization bacteria,mainly KPC enzyme-producing.There were 91 patients with CRE infection,accounting for 33.83%(91/269)of the total sample size,with pulmonary infection as the main type of infection and Klebsiella pneumoniae as the main drug-resistant bacteria.2.The results of univariate analysis of the CRE intestinal colonization group and the non-CRE intestinal colonization group showed that past history of CRE infection,diabetes mellitus,indwelling gastric tube,tracheal intubation,the application of polymyxin within 14 days,more than 7 days of mechanical ventilation,high APACHEⅡ score,and high SOFA score were risk factors for CRE intestinal colonization.The results of the multifactorial analysis showed that past history of CRE infection,the application of polymyxin within 14 days,more than 7 days of mechanical ventilation,high APACHEⅡ score,and high SOFA score were independent risk factors for CRE intestinal colonization.3.The results of the univariate analysis in the CRE-infected group and the nonCRE-infected group showed that CRE colonization,indwelling gastric tube,tracheal intubation,indwelling central venous catheter,≥3 antibiotics,more than 7 days of mechanical ventilation,high APACHE Ⅱ score and high SOFA score of patients were risk factors for CRE infection.The results of the multifactorial analysis showed that CRE colonization,≥3 antibiotics,more than 7 days of mechanical ventilation and high APACHEⅡ score of patients were independent risk factors for CRE infection.4.ROC curve analysis of prognosis by APACHE II score,SOFA score,CRE infection,and the time of screening out CRE showed that high APACHE II score,high SOFA score,CRE infection,and early carrier all predicted poor prognosis.ConclusionThe proportion of patients with CRE intestinal colonization in the ICU is 48.70%,with Klebsiella pneumoniae as the main colonization bacteria,mainly KPC enzymeproducing.The proportion of patients with CRE infection is 33.83%,which are mainly pulmonary infections caused by carbapenem-resistant Klebsiella pneumoniae.CRE colonization and infection are mainly related to invasive procedures and antimicrobial drug treatment,and the severity of the disease.CRE intestinal colonization can lead to CRE pulmonary infection,which then can lead to CRE intestinal colonization,so the intestinal-pulmonary axis may be an important mechanism of CRE colonization and CRE infection.