早产儿感染耐美罗培南肺炎克雷伯菌的危险因素分析  

Risk factors of meropenem-resistant Klebsiella pneumoniae infections in preterm infants

作　　者：吴夏萍[1] 郭少青[1] 钟美珍[1] 郑青青[1] 吴谨准[1] 

机构地区：[1]厦门大学附属第一医院儿科新生儿病区,福建厦门361003

出　　处：《中华医院感染学杂志》2016年第4期925-927,共3页Chinese Journal of Nosocomiology

基　　金：福建省自然科学基金资助项目(C9910021)

摘　　要：目的探讨早产儿感染耐美罗培南肺炎克雷伯菌的危险因素,从而更有针对性地预防治疗肺炎克雷伯菌感染。方法 2013年3月-2015年3月对医院65例早产儿确诊感染耐美罗培南肺炎克雷伯菌的临床资料进行回顾性分析,并与同期住院122例早产儿对美罗培南敏感肺炎克雷伯菌进行比较,对肺炎克雷伯菌医院感染的危险因素进行分析。结果单因素分析显示,早产儿耐美罗培南肺炎克雷伯菌感染的危险因素包括,出生胎龄、出生体质量、住院天数≥1个月、接受过机械通气≥5d、经外周静脉穿刺中心静脉插管、静脉营养≥2周、使用美罗培南抗菌药物治疗（≥7d）、使用三代头孢抗菌药物等,差异有统计学意义（P〈0.05）;多因素logistic回归分析发现,使用美罗培南治疗（≥7d）为独立危险因素（OR=2.756,95%CI 1.083~7.014）。结论根据药敏试验结果,合理使用抗菌药物,减少早产儿美罗培南不必要的使用,以减少其耐药性发生,有利于控制耐美罗培南肺炎克雷伯菌的传播。OBJECTIVE To investigate risk factors of meropenem-resistant Klebsiella pneumoniae infections in premature infants,so as to conduct more effective targeted prevention and treatment of K.pneumoniae infections.METHODS Clinical data of premature infants diagnosed with meropenem-resistant K.pneumoniaeinfections during Mar.2013-Mar.2015 were retrospectively analyzed and compared with 122 hospitalized children carrying meropenem-sensitive K.pneumoniae during the same period to analyze risk factors of nosocomial infections caused by K.pneumoniae.RESULTS Univariate analysis showed that risk factors of meropenem-resistant K.pneumoniaeinfection in preterm infants included gestational age,birth weight,hospital stays≥1month,mechanical ventilation≥5d,peripherally inserted central venous catheter,intravenous nutrition≥ 2weeks,use of antibiotic meropenem for treatment（≥7d）,and use of third-generation cephalosporin antibiotics,with statistical significance（P〈0.05）.Multivariate logistic regression analysis showed that independent risk factors included use of meropenem therapy（≥7d）（OR = 2.756;95% CI,1.083-7.014）.CONCLUSIONClinicians should make rational use of antibiotics based on susceptibility test results to minimize unnecessary use of meropenem in premature infants to reduce drug resistance,which helps to control the spread of meropenem-resistant K.pneumoniae.

关 键 词：早产儿 肺炎克雷伯菌 美罗培南 危险因素 

分 类 号：R722.6[医药卫生—儿科]