新生儿重症监护患者耐碳青霉烯类肺炎克雷伯菌定植发展为感染的危险因素分析  

Risk factors for development of infection from colonization of carbapenem-resistant Klebsiella pneumoniae in neonates in neonatal intensive care unit

作　　者：殷丽军[1] 杨韦菁 缪瑾[1] 王晓华[1] 何磊燕 王传清[1,2] YIN Li-jun;YANG Wei-jing;MIAO Jin;WANG Xiao-hua;HE Lei-yan;WANG Chuan-qing(Department of Healthcare-associated Infection Control and Health Care,Affiliated Pediatric Hospital of Fudan University,Shanghai 201102,China;Bacteria Room of Clinical Laboratory Center,Affiliated Pediatric Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院院内感染控制与防保科,上海201102 [2]复旦大学附属儿科医院临床检验中心细菌室,上海201102

出　　处：《中国感染控制杂志》2022年第1期15-21,共7页Chinese Journal of Infection Control

摘　　要：目的探讨新生儿重症监护病房(NICU)患者耐碳青霉烯类肺炎克雷伯菌(CRKP)定植情况及由定植发展为临床感染的危险因素分析。方法选取某院2017年1月—2018年12月NICU的新生儿为研究对象,自2017年1月开始开展住院新生儿入院后48 h内及住院期间每周进行一次CRKP肛拭子/咽拭子主动筛查,同时进行CRKP感染监测。应用SPSS 23.0统计软件进行数据分析。结果共有1230例NICU新生儿进行了主动筛查,110例新生儿CRKP阳性,CRKP定植率8.9%,其中肠道定植率8.1%(97/1197),高于上呼吸道(5.2%,49/945),差异有统计学意义(P=0.008)。胎龄、低出生体重和住院时间延长是CRKP定植的危险因素(均P<0.001)。Diversilab同源性监测发现,CRKP定植发展为临床感染的概率为19.1%(21/110)。机械通气(OR=10.177,95%CI为2.667~38.830,P=0.013),新生儿营养风险评估高(OR=0.251;95%CI为0.072~0.881,P=0.031)以及新生儿危重评分-Ⅱ(SNAP-Ⅱ)高(OR=8.256,95%CI为6.072~20.881,P=0.025)是CRKP定植新生儿发展为CRKP临床感染的独立危险因素。结论CRKP定植增加NICU新生儿住院期间CRKP感染的概率,重点关注接受机械通气、营养不良和SNAP-Ⅱ评分高的新生儿,减少CRKP临床感染的发生。Objective To evaluate the colonization of carbapenem-resistant Klebsiella pneumoniae(CRKP)in neo-nates in neonatal intensive care unit(NICU),and analyze the risk actors for development of clinical infection from colonization.Methods Neonates in NICU of a hospital from January 2017 to December 2018 were selected as the research object.Since January 2017,active screening of CRKP anal swab/pharyngeal swab was carried out once a week within 48 hours after admission and during hospitalization period,monitoring on CRKP infection was performed at the same time,data was analyzed with SPSS 23.0 statistical software.Results A total of 1230 NICU neonates were actively screened,110 neonates were CRKP positive,CRKP colonization rate was 8.9%,8.1%(97/1197)of which was intestinal colonization,which was significantly higher than that(5.2%,49/945)of the upper respiratory tract,difference was significant(P=0.008).Gestational age,low birth weight and prolonged hospital stay were risk factors for CRKP colonization(all P<0.001).Diversilab homology monitoring found that the probability of CRKP colonization developing into clinical infection was 19.1%(21/110).Mechanical ventilation(OR,10.177[95%CI,2.667-38.830],P=0.013),high assessment on neonatal nutritional risk(OR,0.251[95%CI,0.072-0.881],P=0.031)and high score for neonatal acute physiology-Ⅱ(SNAP-Ⅱ)(OR,8.256[95%CI,6.072-20.881],P=0.025)were independent risk factors for the development of CRKP clinical infection in CRKP-colonized neonates.Conclusion CRKP colonization increases the probability of CRKP infection in NICU neonates during hospitalization,neonates receiving mechanical ventilation,malnutrition and high SNAP-Ⅱscore should be paid attention,so as to reduce the occurrence of CRKP clinical infection.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 定植 感染 新生儿 重症监护 危险因素 

分 类 号：R181.32[医药卫生—流行病学]