新生儿碳青霉烯类耐药肺炎克雷伯菌的耐药性及其定植的危险因素分析  

Drug resistance of carbapenem-resistant Klebsiella pneumonia colonized in neonates and risk factors of its clonization

作　　者：曹阳[1] 毛静秋 魏殿军[1] 李鑫[1] 陈薇[1] 

机构地区：[1]天津医科大学第二医院检验科,300211

出　　处：《中华临床感染病杂志》2015年第5期407-412,共6页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的：探讨新生儿科病房碳青霉烯类耐药肺炎克雷伯菌（ CRKP ）的耐药性及新生儿发生CRKP定植的危险因素。方法连续收集2012年1月至2014年6月在天津医科大学第二医院新生儿科病房住院、咽拭子培养结果为肺炎克雷伯菌的病例资料，共108例。采用病例对照研究方法分两组，病例组为定植CRKP的新生儿23例，对照组为定植碳青霉烯类敏感肺炎克雷伯菌（ CSKP ）的新生儿85例。采用χ2检验和Fisher确切概率法比较两组肺炎克雷伯菌对21种抗菌药物的耐药性，对两组病例进行单因素及Logistic多因素回归分析，了解新生儿发生CRKP定植的危险因素。结果CRKP对多种青霉素类和头孢菌素类抗菌药物及复方磺胺甲噁唑的耐药率高达100％，对碳青霉烯类的美罗培南和亚胺培南的耐药率分别为95.7％和87.0％。除对阿米卡星、庆大霉素、环丙沙星、四环素的敏感率为100％外，CRKP对其他16种抗菌药物的耐药率均明显高于CSKP（P值均＜0.05）。单因素分析结果显示，使用头孢西丁（χ2＝20.053，P＜0.01）、吸痰（χ2＝15.817，P＜0.01）、胃肠减压（χ2＝10.731，P＜0.01）、鼻饲（χ2＝15.146，P＜0.01）、侵入性操作种类（χ2＝22.572，P＜0.01）、胎儿出生体质量（χ2＝6.026，P＜0.05）、检出CRKP／CSKP的累计培养次数（χ2＝18.577，P＜0.01）、母亲妊娠高血压综合征（χ2＝8.698，P＜0.01）、早产（χ2＝4.904，P＜0.05）、产前住院经历（χ2＝8.396，P＜0.01）、小于胎龄儿（χ2＝7.295，P＜0.05）、胎龄（χ2＝7.294，P＜0.05）、胎膜早破（χ2＝9.397，P＜0.01）、住院天数（χ2＝14.649，P＜0.01）和新生儿重症监护病房（NICU）收治（χ2＝11.050，P＜0.01）是新生儿发生CRKP定植的危险因素。多因素回归分析结果显示，母亲妊娠高血压综合征（ OR＝9.718，P＜0.01）、胎膜早破（＜24 h）（OR＝6.640，P＜0.01）和NICU�Objective To study drug resistance of carbapenem-resistant Klebsiella pneumonia （ CRKP） in neonates hospitalized in the neonatal unit , and to identify the risk factors for CRKP colonization in neonates .Methods Totally 108 neonates with Klebsiella pneumonia colonization admitted in Department of Neonates , the Second Hospital of Tianjin Medical University during January 2012 and June 2014 were enrolled in the study , including 23 cases with CRKP colonization （ case group ） and 85 cases with carbapenem-sensitive Klebsiella pneumonia （CSKP） colonization （control group）.Chi-square test and fisher exact test were used to compare the differences in resistance to 21 antibiotics between CRKP and CSKP . Univariate analysis and Logistic regression analysis were performed to identify the risk factors for CRKP colonization in neonates .Results All of the CRKP strains were resistant to penicillins , cephalosporins and＆nbsp;SMZco, and 95.7% and 87.0% of the CRKP strains were resistant to meropenem and imipenem , respectively.All of the CRKP strains were susceptible to amikacin , gentamicin, ciprofloxacin and tetracycline, but were highly resistant to the rest 16 antibiotics compared with CSKP strains （all P〈0.05）. Univariate analysis showed that 14 factors were associated with CRKP colonization： exposure to cefoxitin （χ2 =20.053, P〈0.01）, sputum suction （χ2 =15.817, P〈0.01）, gastrointestinal decompression （χ2 =10.731, P〈0.01）, nasogastric feeding （χ2 =15.146, P〈0.01）, invasive procedure （χ2 =22.572, P〈0.01）, birth weight （χ2 =6.026, P〈0.05）, frequency of sampling for CRKP/CSKP （χ2 =18.577, P〈0.01）, hypertension of pregnancy （χ2 =8.698, P〈0.01）, premature birth （χ2 =4.904, P〈0.05）, prenatal hospitalization experience （χ2 =8.396, P〈0.01）, adequacy for gestational age （χ2 =7.295, P〈0.05）, gestational age （χ2 =7.294, P〈0.05）, rupture of membranes （χ2 =9.397, P〈0.01）, length of hospitalization （χ2 =14.649, P〈0

关 键 词：婴儿 新生 克雷伯菌 肺炎 碳青霉烯类 抗药性 定植 危险因素 

分 类 号：R446.5[医药卫生—诊断学]