新生儿CRKP院内感染性肺炎的治疗效果及危险因素分析  

Analysis of therapeutic effect and risk factors of hospital-acquired pneumonia in neonates with carbapenem resistant Klebsiella pneumoniae

作　　者：刘媛 刘增芳 贺兆平 宋彩虹[1] LIU Yuan;LIU Zeng-fang;HE Zhao-ping;SONG Cai-hong(Neonatal Department,Yulin Second Hospital,Yulin 719000,Shannxi,CHINA;Department of Pediatrics,Yulin Second Hospital,Yulin 719000,Shannxi,CHINA)

机构地区：[1]榆林市第二医院新生儿科,陕西榆林719000 [2]榆林市第二医院儿科,陕西榆林719000

出　　处：《海南医学》2021年第14期1806-1809,共4页Hainan Medical Journal

摘　　要：目的研究新生儿患耐碳青霉烯类肺炎克雷伯菌(CRKP)院内感染性肺炎(HAP)的危险因素及临床治疗效果。方法选择2017年2月至2020年8月在榆林市第二医院就诊的92例分离出肺炎克雷伯菌(KP)病株的HAP患儿作为研究对象,据药敏情况将36例CRKP患儿作为观察组,56例碳青霉烯类敏感性肺炎克雷伯菌(CSKP)患儿作为对照组。收集患儿相关临床资料并行常规经验治疗1周,比较两组患儿的相关临床资料,采用多因素Logistic回归分析探索HAP患儿感染CRKP发生的危险因素;同时比较两组患儿的临床治疗效果。结果观察组和对照组患儿对米诺环素耐药率最低,分别为2.78%、0,对β-内酰胺类抗生素(氨苄西林)耐药率最高,分别为97.22%、80.36%;观察组患儿对氨苄西林、阿莫西林、头孢哌酮、头孢吡肟、亚胺培南、美罗培南、庆大霉素、妥布霉素、环丙沙星、左旋氧氟沙星的耐药率明显高于对照组,差异均有统计学意义(P<0.05);单因素分析结果显示,观察组患儿住院≥7 d、机械通气≥5 d、伴置管史、伴碳青霉烯酶类用药史比例明显高于对照组,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,住院≥7 d、机械通气≥5 d、既往伴置管史、碳青霉烯酶类用药史是促进HAP患儿感染CRKP发生的危险因子(P<0.05);接受同等经验性治疗后,观察组患儿的总有效率为72.22%,明显低于对照组为89.29%,差异具有统计学意义(P<0.05)。结论HAP患儿感染CRKP的危险因素包括住院及机械通气时间、伴置管史及碳青霉烯酶类用药史,感染后治疗效果相对较差。Objective To study the risk factors and clinical treatment effect of hospital-acquired pneumonia(HAP)caused by carbapenem-resistant Klebsiella pneumoniae(CRKP)in neonates.Methods A total of 92 HAP children with Klebsiella pneumoniae(KP)isolated from the Yulin Second Hospital from February 2017 to August 2020 were selected as research objects.According to the drug sensitivity,36 children with CRKP were taken as observation group,and 56 children with carbapenem-sensitive Klebsiella pneumoniae(CSKP)were selected as control group.Clinical data of children were collected,which were treated by routine experience for 1 week.The clinical data between the two groups of children were collected.Multivariate Logistic regression analysis was used to explore the risk factors of CRKP infection in HAP children.The clinical therapeutic effects between the two groups of children were compared.Results The resistance rates of observation group and control group to minocycline were the lowest(2.78%,0),respectively,and the resistance rates toβ-lactam antibiotics(ampicillin)were the highest(97.22%,80.36%).The resistance rates of children in observation group to ampicillin,amoxicillin,cefoperazone,cefepime,imipenem,meropenem,gentamicin,tobramycin,ciprofloxacin and levofloxacin were significantly higher than those in control group(P<0.05).Univariate results showed that the proportion of hospitalized children≥7 days,mechanical ventilation≥5 days,history of indwelling catheter,and history of carbapenemases in observation group was significantly higher than those in control group(P<0.05).Multivariate Logistic regression analysis showed that hospitalization≥7 days,mechanical ventilation≥5 days,previous history of indwelling catheter,and history of carbapenemases medication were risk factors for CRKP infection in HAP children(P<0.05).After receiving the same empirical treatment,the total effective rate in the observation group was 72.22%,which was significantly lower than 89.29%in the control group(P<0.05).Conclusion Risk factors of

关 键 词：新生儿 耐碳青霉烯类肺炎克雷伯菌 院内感染性肺炎 危险因素 疗效 

分 类 号：R722.13[医药卫生—儿科]