摘要目的:探讨造成碳青霉烯类耐药的肠杆菌目细菌（CRE）感染和感染后死亡的危险因素。方法:对2018年北京地区18家二级或三级甲等临床医院共482例住院患者进行病例对照分析，以感染CRE的患者为病例组（ n=247），以感染碳青霉烯类敏感的肠杆菌目细菌（CSE）的患者为对照组（ n=235）。通过单因素和多因素logistic回归分析CRE感染的危险因素和临床预后。 结果:CRE菌株对大多数的抗菌药物耐药，但对黏菌素和替加环素敏感率较高，分别为94.0%和99.5%。多因素分析显示，感染前30 d内气管插管（ OR=2.607，95 %CI：1.655~4.108， P<0.001），以及使用过三/四代头孢菌素（ OR=2.339，95 %CI：1.438~3.803， P=0.001）、碳青霉烯类（ OR=2.468，95 %CI：1.610~3.782， P<0.001）和喹诺酮类药物（ OR=2.042，95 %CI：1.268~3.289， P=0.003）是CRE感染的独立危险因素。机械通气（ OR=3.390，95 %CI：1.454~7.904， P=0.005）、心力衰竭（ OR=4.679，95 %CI：1.975~11.083， P<0.001）、中重度肝病（ OR=3.057，95 %CI：1.061~8.806， P=0.038）、感染前30 d内使用喹诺酮类药物（ OR=2.882，95 %CI：1.241~6.691， P=0.014）以及发生感染性休克（ OR=7.772，95 %CI：3.505~17.233， P<0.001）是CRE感染后死亡的独立危险因素。 结论:减少感染前30 d内抗菌药物使用和气管插管等侵入性操作可能会降低患者感染CRE的概率。依据基础疾病严重程度对CRE感染患者进行分级治疗，预测和预防感染性休克的发生将有助于降低患者死亡风险。

abstractsObjective:To explore the risk factors for carbapenem-resistant Enterobacterales (CRE) infection and death. Methods:A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group ( n=247), and infected by carbapenem susceptible Enterobacterales (CSE) as the control group ( n=235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis. Results:CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation ( OR=2.607, 95 %CI: 1.655-4.108, P<0.001), empirical treatment using third or fourth generation cephalosporins ( OR=2.339, 95 %CI: 1.438-3.803, P=0.001), carbapenems ( OR=2.468, 95 %CI: 1.610-3.782, P<0.001) and quinolones ( OR=2.042, 95 %CI: 1.268-3.289, P=0.003) were independent risk factors for CRE infection. Mechanical ventilation ( OR=3.390, 95 %CI: 1.454-7.904, P=0.005), heart failure ( OR=4.679, 95 %CI: 1.975-11.083, P<0.001), moderate or severe liver disease ( OR=3.057, 95 %CI: 1.061-8.806, P=0.038), prior 30-day quinolones exposure ( OR=2.882, 95 %CI: 1.241-6.691, P=0.014) and septic shock ( OR=7.772, 95 %CI: 3.505-17.233, P<0.001) were independent risk factors for death after CRE infection. Conclusions:Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.