早产儿耐碳青霉烯类肺炎克雷伯菌败血症23例临床分析  

Clinical analysis of 23 cases of carbapenem-resistant klebsiella pneumoniae sepsis in premature infants

作　　者：李书津[1] 徐发林[1] 李文丽[1] 段佳佳[1] Li Shujin;Xu Falin;Li Wenli;Duan Jiajia(Department of Neonatology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,450052

出　　处：《中华新生儿科杂志（中英文）》2019年第5期329-333,共5页Chinese Journal of Neonatology

摘　　要：目的探讨早产儿耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant klebsiella pneumoniae,CRKP)败血症患儿的临床表现、高危因素、治疗及预后.方法选取2015年4月至2018年3月郑州大学第三附属医院新生儿病房收治的确诊肺炎克雷伯菌败血症早产儿,根据药物敏感试验结果分为CRKP组和非CRKP组.回顾性分析两组患儿临床表现、高危因素、治疗及预后.结果共纳入肺炎克雷伯菌败血症早产儿39例,其中CRKP组23例,胎龄(29.5±0.6)周,出生体重(1177±272)g;非CRKP组16例,胎龄(30.0±0.5)周,出生体重(1387±220)g.单因素Logistic回归分析显示,出生体重低是早产儿感染CRKP败血症的危险因素(OR=1.203,95%CI 1.068~1.355,P=0.002).CRKP组败血症患儿需联合用药和感染后发生颅内出血比例高于非CRKP组,差异有统计学意义(P<0.05).CRKP败血症联合用药患儿感染前1周使用抗生素的比例及使用时间明显高于单一用药患儿,且单因素Logistic回归分析显示,感染前1周使用抗生素是CRKP败血症早产儿需联合用药的危险因素(OR=10.500,95%CI 1.015~108.577,P=0.049).CRKP组治愈13例,好转7例,存活率87.0%(20/23),放弃2例,死亡1例;非CRKP组治愈12例,好转2例,存活率87.5%(14/16),放弃0例,死亡2例.结论出生体重越低,感染CRKP败血症的风险越大;CRKP败血症早产儿需联合使用抗生素的比例更高,感染前1周使用抗生素是CRKP败血症早产儿需抗生素联合药物治疗的危险因素.Objective To study the clinical manifestations, risk factors, treatment and prognosis of carbapenem-resistant klebsiella pneumoniae (CRKP) sepsis in premature infants. Method A retrospective analysis was done for the premature infants diagnosed with klebsiella pneumoniae sepsis and admitted to the neonatal wards of the Hospital from April 2015 to March 2018. According to the results of drug sensitive test, the infants was assigned to CRKP group and non-CRKP group. The perinatal factors, clinical manifestations, treatment, and prognosis of the two groups were analyzed. Furthermore, high risk factors for CRKP group were analyzed. Result A total of 39 premature infants with KP sepsis were included in our study. There were 23 cases in the CRKP group and 16 cases in the non-CPAP group. In CPKP group, the gestational age was (29.5±0.6) weeks, the birth weight was (1 177±272) g. In non-CRKP group, the gestational age was (30.0±0.5) weeks, the birth weight was (1 387±220) g. Univariate Logistic regression analysis showed that low birth weight was a risk factor for CRKP sepsis in premature infants (OR=1.203, 95%CI 1.068~1.355, P=0.002). The proportion of that required combination treatment with antibiotics and the incidence of intracranial hemorrhage after infection in the CPKP group were both higher than that in the non-CRKP group (P<0.05). The proportion and duration of antibiotics used in the first week before the onset of infection in infants with CRKP sepsis and combined antibiotic treatment were significantly higher than those in infants with CPKP sepsis and single antibiotic treatment. The use of antibiotics in the first week before the onset of infection was an independent risk factor for the combined drug treatment of premature infants with CRKP sepsis (OR=10.500, 95%CI 1.015~108.577, P=0.049). In the CRKP group, the improvement rate was 87.0%(20/23), 2 cases were withdrew, and 1 case deceased. In the non-CPKP group, the improvement rate was 87.5%(14/16), and 2 deceased. Conclusion The lower the birth weight,

关 键 词：克雷伯菌 肺炎 抗药性 细菌 碳青霉烯类抗生素 败血症 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]