新生儿重症监护室多重耐药菌感染临床分析及高危因素  

Clinical characteristics and factors of multiple drug-resistant organism infection in neonatal intensive care unit

作　　者：李管明 张霭润 王启闯 李宁宁 庄思齐[1] 房晓祎 Li Guanming;Zhang Airun;Wang Qichuang;Li Ningning;ZhuangSiqi;Fang Xiaoyi(Department of Neonatology,Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;Department of Science and Research Center,Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China)

机构地区：[1]中山大学附属第七医院新生儿科,深圳市518107 [2]中山大学附属第七医院科研中心,深圳市518107

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第3期185-191,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：2020年国家自然科学基金面上项目(No.82072766);2020年深圳市科技计划项目基础研究面上项目(No.JCYJ20190809145409829);2020年深圳市医疗卫生三名工程项目(No.SZSM202011004)。

摘　　要：目的探讨新生儿重症监护室(NICU)新生儿多重耐药菌(MDRO)感染的高危因素及其预防策略。方法收集2019年1月至2020年12月中山大学附属第七医院NICU住院新生儿中病原体培养阳性患儿的临床资料,其中检出MDRO的新生儿为MDRO组(25例),检出非MDRO的新生儿为非MDRO组(45例),回顾性分析MDRO构成比、菌种、检出部位及耐药情况,并分析两组新生儿的疾病及转归,采用单因素分析和多因素Logistic回归分析MDRO感染的高危因素。结果714份送检标本中分离出细菌70株,其中MDRO 25株(35.7%)。MDRO中革兰阳性球菌15株(60.0%),其中凝固酶阴性葡萄球菌12株(48%),耐甲氧西林金黄色葡萄球菌3株(12.0%);革兰阴性杆菌10株(40.0%),其中产超广谱β-内酰胺酶大肠埃希菌6株(24.0%)。单因素分析显示两组新生儿的绒毛膜羊膜炎发生率[16(64.0%)vs.17(37.7%):χ^(2)=4.435、P=0.035]、联合使用2种以上抗菌药物[10(40.0%)vs.8(17.7%):χ^(2)=4.155、P=0.042]、肠外营养时间超过2周[15(60.0%)vs.15(33.3%):χ^(2)=4.667、P=0.031]差异均有统计学意义。多因素Logistic回归分析显示,绒毛膜羊膜炎为NICU新生儿MDRO感染的独立危险因素(OR=2.899、95%CI:1.007~8.350、χ^(2)=3.889、P=0.049)。MDRO组患儿主要感染疾病为新生儿败血症[6例(24.0%)]和新生儿肺炎[6例(24.0%)];非MDRO组患儿主要感染疾病为化脓性脑膜炎[2例(4.4%)]和新生儿肺炎[2例(4.4%)]。MDRO组患儿感染率高于非MDRO组[14(56.0%)vs.5(11.1%):χ^(2)=16.376、P<0.001],两组患儿住院转归[24(96.0%)vs.43(95.5%):χ^(2)=0.000、P=1.000]、住院时间[21.0(7.5,37.0)d vs.8.0(4.0,35.5)d:Z=-1.793、P=0.073]以及住院费用[3.588(1.0395,8.7050)万元vs.1.3713(0.7287,7.6127)万元:Z=-1.189、P=0.234]差异均无统计学意义。结论NICU患儿MDRO感染率较非MDRO高,绒毛膜羊膜炎为NICU新生儿MDRO感染独立危险因素。应从积极处理母亲羊膜炎、围产期抗菌药物合理使用、加强感染控制等方面进行NObjective To investigate the high-risk factors and prevention strategies of multiple drug-resistant organisms(MDRO)infection in neonatal intensive care unit(NICU).Methods Clinical data of the neonates with positive pathogen cultures who were hospitalized in the NICU of the Seventh Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were collected.The 25 neonates with positive MDRO culture results were assigned as MDRO group,while 45 neonates with non-MDRO culture results were assigned as non-MDRO group.The composition ratio,strain,detected sites and drug resistance of MDRO were analyzed,retrospectively,and the disease and outcome of both neonatal groups were compared.The high-risk factors for MDRO infection were analyzed by Univariate analysis and multivariate Logistic regression analysis.Results Total of 70 strains of pathogens were isolated from 714 samples,among which,25 strains(35.7%)were MDRO.15 strains(60.0%)of MDRO were Gram-positive cocci,among which,12 strains(48.0%)were coagulase-negative Staphylococci and 3 strains(12.0%)were methicillin-resistant Staphylococcus aureus.10 strains were Gram-negative bacilli(40%),among which,6 strains(24.0%)were Escherichia coli producing extended-spectrum beta-lactamase.Univariate analysis showed that chorioamnionitis[16(64.0%)vs.17(37.7%):χ^(2)=4.435,P=0.035],combined usage of more than two antibiotics[10(40.0%)vs.8(17.7%):χ^(2)=4.155,P=0.042]and administration of parenteral nutrition for longer than 2 weeks[15(60.0%)vs.15(33.3%):χ^(2)=4.667,P=0.031]of the two groups were with significant differences.Logistic regression analysis showed that chorioamnionitis was an independent risk factor for neonatal with MDRO infection in NICU[OR=2.899,95%CI:1.007-8.350),χ^(2)=3.889,P=0.049].The main infectious diseases of neonates in MDRO group were sepsis(6/25,24.0%)and pneumonia(6/25,24.0%),while those in non-MDRO group were purulent meningitis(2/45,4.4%)and pneumonia(2/45,4.4%).The infection rate of neonates in MDRO group was significantly higher t

关 键 词：多重耐药菌 高危因素 新生儿 新生儿重症监护室 

分 类 号：R722.1[医药卫生—儿科]