儿童多重耐药肺炎克雷伯杆菌脓毒症感染的危险因素分析  

Risk factors for multidrug-resistant Klebsiella pneumoniae sepsis in children

作　　者：程超[1] 林业鑫[1] 李玖军[1] 张智洁[2] 

机构地区：[1]中国医科大学附属盛京医院PICU,辽宁沈阳110004 [2]中国医科大学附属盛京医院检验科,辽宁沈阳110004

出　　处：《中国当代儿科杂志》2015年第9期932-936,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨多重耐药肺炎克雷伯杆菌(MDR-KP)脓毒症感染的危险因素,为防止和减少MDRKP脓毒症的发生以及合理使用抗生素提供参考依据。方法采用回顾性病例对照研究方法,选取2010年3月至2014年2月41例MDR-KP脓毒症患儿作为病例组,选择同期53例非MDR-KP脓毒症患儿作为对照组。采用多元logistic回归分析对肺炎克雷伯杆菌脓毒症感染的独立危险因素进行评价。结果病例组感染前PICU住院天数、感染前机械通气天数、机械通气总天数及感染前抗生素使用天数均明显长于对照组(P<0.05),感染前抗生素使用种类及病死率均明显高于对照组(P<0.05)。Logistic回归分析结果显示感染前抗生素使用种类及使用三代头孢、碳青霉烯类抗生素是MDR-KP感染的独立危险因素(P<0.05)。结论合理使用抗生素是防止MDR-KP感染发生的有效措施。Objective To explore the risk factors for sepsis caused by multidrug-resistant Klebsiella pneumonia （MDR-KP） and to provide a reference for the prevention of MDR-KP sepsis and rational use of antibiotics. Methods A retrospective case-control study of 41 children with MDR-KP sepsis （case group） and 53 pediatric patients without MDR-KP sepsis （control group） between March 2010 and Febrary 2014 was conducted. Multiple logistic regression analysis was performed to estimate the independent risk factors for MDR-KP sepsis. Results Compared with the control group, the case group had a longer length of stay in the PICU before infection （P〈0.05）, more prolonged duraion of mechanical ventilation before infection （P〈0.05）, a larger total number of days of mechanical ventilation （P〈0.05）, more days of antibiotic use before infection （P〈0.05）, more types of antibiotics used before infection （P〈0.05）, and a higher mortality （P〈0.05）. The logistic regression analysis showed that more types of antibiotics used before infection and use of third-generation cephalosporin and carbapenems were independent risk factors for MDR-KP sepsis （P〈0.05）. Conclusions Rational use of antibiotics is an effective measure to prevent MDR-KP sepsis.

关 键 词：多重耐药肺炎克雷伯杆菌 脓毒症 危险因素 儿童 

分 类 号：R720.597[医药卫生—急诊医学]