儿童检出耐碳青霉烯类肺炎克雷伯菌的影响因素分析  

Influenced factors analysis for detection of carbapenem-resistant Klebsiella pneumoniae in children

作　　者：陈虹宇[1] 黄双双 孙丽芳[1] 赖建威 叶炳均 刘亚丽[1] 姜含芳 CHEN Hongyu;HUANG Shuangshuang;SUN Lifang;LAI Jianwei;YE Bingjun;LIU Yali;JIANG Hanfang(Department of Clinical Laboratory,Shenzhen Children′s Hospital,Shenzhen,Guangdong 518026,China;Medical Laboratory Technology,Basic Department of Medical College,Jiaying University,Meizhou,Guangdong 514000,China)

机构地区：[1]广东省深圳市儿童医院检验科,广东深圳518026 [2]嘉应学院医学院基础部医学检验技术,广东梅州541000

出　　处：《检验医学与临床》2021年第2期168-171,共4页Laboratory Medicine and Clinic

基　　金：广东省深圳市科技计划项目(JCYJ20160429181145972)。

摘　　要：目的探讨儿童检出耐碳青霉烯类肺炎克雷伯菌(CRKP)的影响因素,以进一步指导临床医生对CRKP的感染进行有效预防和治疗。方法选择深圳市儿童医院2013年1月至2018年12月检出CRKP的住院患儿(病例组)以及同期检出对碳青霉烯类药物敏感的肺炎克雷伯菌(CSKP)感染患儿(对照组)为研究对象,每组60例。比较两组的相关资料,采用多因素Logistic回归分析儿童检出CRKP的影响因素。结果病例组与对照组入住ICU情况,检出前住院天数[9.00(5.00,20.25)d vs.3.00(2.00,10.25)d],气管插管、胃管插管、引流管使用情况,检出前一联、二联、三联及以上抗菌药物使用情况,第三代头孢菌素、舒巴坦/他唑巴坦制剂、糖肽类、碳青霉烯类抗菌药物的使用情况,检出前使用抗菌药物时间>1周,伴随心血管疾病情况比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现,检出前住院天数是儿童检出CRKP感染的独立危险因素,而检出前使用一联抗菌药物是儿童检出CRKP感染的保护因素。结论对于CRKP感染的患儿,临床应采取减少侵入性操作,规范广谱抗菌药物的使用,加强医院感染监控等措施,从而预防与减少CRKP医院感染的发生和传播。Objective To explore the clinical risk factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)in children so as to further guide clinicians to effectively prevent and treat CRKP infection.Methods A retrospective study was conducted to collect the medical records of 60 in-patients with CRKP(case group)detected in Shenzhen Children′s Hospital from January 2013 to December 2018 and 60 in-patients with carbapenem-sensitive Klebsiella pneumoniae(CSKP,control group)detected in the same period.Multivariate Logistic regression model were used to analyze the risk factors of CRKP.Results Condition of ICU stay,hospitalization days[9.00(5.00,20.25)d vs.3.00(2.00,10.25)d],endotracheal intubation,gastric intubation,use of drainage tube,use of antibiotics(single antimicrobial usage,two antimicrobial combined and three and above combined antimicrobial usage),third generation cephalosporins,sulbactam/tazobactam preparations,glycopeptides and carbapenems,time of usage of antibacterial agents higher than one week,accompanied by cardiovascular diseases between the two groups had statistical significance(P<0.05).Multivariate Logistic regression analysis showed that the length of hospitalization was an independent risk factor for CRKP detection in children.However,single antimicrobial usage before detection was the protective factor of children infected with CRKP.Conclusion In order to prevent and reduce the occurrence and spread of CRKP nosocomial infection,we should take measures to reduce invasive operation,standardize the use of broad-spectrum antibiotics and strengthen nosocomial infection surveillance in view of the possible risk factors of CRKP detection in children.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 危险因素 预防 

分 类 号：R446.5[医药卫生—诊断学]