早产儿肠道产超广谱β-内酰胺酶耐药菌定植及其与医院感染脓毒症的符合情况  

Gut colonization of extended - spectrum β - lactamase - producing antibiotic - resistant bacteria in premature infants and its concordance with nosocomial sepsis

作　　者：蔡文红[1] 杨长仪[1] 王俐萍[1] 林秀凤[2] 修文龙[1] 林惠姿 石惠英[1] 林述玲 

机构地区：[1]福建医科大学附属福建省妇幼保健院新生儿科,福州350001 [2]福建医科大学附属福建省妇幼保健院医院感染管理科,福州350001

出　　处：《中华实用儿科临床杂志》2016年第21期1646-1649,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的掌握早产儿肠道产超广谱β－内酰胺酶（ESBLs）耐药菌定植特点及影响因素，探讨其与医院感染脓毒症的符合情况。方法应用前瞻性研究方法，选取2013年5月至2014年5月入住福建省妇幼保健院新生儿科胎龄〈36周、入院年龄≤24 h、住院时间≥14 d的早产儿，出生第1、3、7天采集直肠拭子行产ESBLs耐药菌培养，之后每7 d采集1次，至出生第28天或出院，同时收集临床资料及血培养结果，进行统计学分析。结果共有300例早产儿纳入研究，221例（73.7%）早产儿肠道定植产ESBLs耐药菌。以产ESBLs肺炎克雷伯菌最常见。出生第1天肠道均无产ESBLs耐药菌定植，肠道耐药菌开始定植的时间出现在出生前2周。多因素Logistic逐步回归分析得出不同日龄出现肠道产ESBLs耐药菌定植的独立危险因素不同：出生第3天为母亲产前使用抗生素（OR＝2.091，95%CI：1.089～4.014）；第7天为出生后胃肠道喂养开始时间≥72 h（OR＝3.356，95%CI：1.540～7.312）；第14天为出生胎龄〈34周（OR＝4.011，95%CI：1.864～8.629）、出生体质量≤1 500 g（OR＝7.271，95%CI：3.301～16.016）、入住新生儿重症监护病房（OR＝2.675，95%CI：1.135～6.303）；第21天为出生体质量≤1 500 g（OR＝58.371，95%CI：6.517～522.854）；第28天为使用第3代头孢菌素治疗（OR＝48.000，95%CI：2.404～958.237）。使用青霉素类抗生素治疗（OR＝0.150，95%CI：0.059～0.386）是出生第7天的保护因素，口服益生菌治疗是第14天（OR＝0.221，95%CI：0.106～0.461）和第21天（OR＝0.061，95%CI：0.007～0.539）的保护因素（P均〈0.05）。肠道产ESBLs耐药菌定植的早产儿医院感染脓毒症发生率较肠道无产ESBLs耐药菌定植的明显升高（χ2＝25.155，P＝0.000）。医院感染脓毒症血培养产ESBLs耐药菌阳性病例中，80%直肠拭子培养出抗菌谱相同的同种耐药菌。结论早产儿肠道容易定�Objective To investigate the characteristics and risk factors of extended - spectrum β - lactamase （ESBLs） - producing antibiotic- resistant bacterial gut colonization in premature infants and to explore its concordance with nosocomial sepsis. Methods A prospective surveillance was performed in Fujian Provincial Maternity and Children＇s Health Hospital from May 2013 to May 2014. Preterm infants（ gestational age 〈 36 weeks ,admission within 24 h of birth and hospitalization time 〉t 14 d）were enrolled, and rectal swabs were collected for ESBLs -producing antibiotic - resistant bacteria culture, on the 1st ,3ra ,7 th day after birth, and every 7 days until the 28th day or discharge. The clinical data and the results of blood culture were collected, and statistical analysis was performed. Results A total of 300 patients were enrolled in this study, of whom 221 patients （73.7%） were identified as gut colonization with ES- BLs - producing bacteria, but the most common was ESBLs - producing klebsiella pneumoniae. No ESBLs - producing bacteria colonized in the gut on the first day after birth, and ESBLs - producing bacteria gut colonization mainly ap- peared in the first 2 weeks after birth. Multivariate Logistic regression indentified ：the use of antenatal antibiotics（ OR = 2.091,95 % CI：I. 089 -4. 014 ）was the independent risk factor for ESBLs - producing bacterial gut colonization in pre-mature infants on the 3rd day after birth, the age of first enteral feeding after birth t〉 72 h （ OR = 3. 356,95% CI： 1. 540 - 7.312 ） was the independent risk factor on the 7th day, gestational age 〈 34 weeks （ OR = 4.011,95 % CI： 1. 864 - 8. 629 ） , birth weight ≤1 500 g （ OR = 7.271,95 % CI：3. 301 - 16.016 ） and hospitalization in neonatal intensive care unit （NICU） after birth（ OR = 2. 675,95% CI：1. 135 -6. 303）were the independent risk factors on the 14th day, birthweight ≤1 500 g（ OR =58. 371,95% C1：6. 517 -522. 854）was the independent risk factor on the 21＇h

关 键 词：耐药菌 定植 医院感染 脓毒症 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]