新生儿多重耐药革兰阴性杆菌感染现况及全因死亡分析  

Status and all-cause mortality of multidrug resistant gram-negative bacteria infection in neonates

作　　者：徐彦磊[1] 李高攀 罗源[1] 郝庆飞[1] 张勤[1] 张凌 陈永宁[1] 程秀永[1] Xu Yanlei;Li Gaopan;Luo Yuan;Hao Qingfei;Zhang Qin;Zhang Ling;Chen Yongning;Cheng Xiuyong(Department of Neonatology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院新生儿科,郑州450052

出　　处：《中华实用儿科临床杂志》2024年第5期337-341,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的:探讨新生儿多重耐药革兰阴性杆菌(MDR-GNB)感染的病原学特点、抗生素方案、治疗结局及全因死亡因素。方法:采用回顾性队列研究的方法对2018年1月至2022年12月郑州大学第一附属医院112例MDR-GNB感染患儿的临床资料进行分析,根据病原菌是否耐碳青霉烯类抗生素分为耐碳青霉烯组和非耐碳青霉烯组。根据结局分为死亡组和存活组。采用χ^(2)检验或Fisher′s精确检验比较组间差异。结果:1.共纳入112例培养阳性病例。中位胎龄和中位出生体重分别为30周和1400 g,培养阳性时中位日龄18 d。2.阳性标本131份,其中下呼吸道分泌物或灌洗液标本67例(51.15%)、血液标本49例(37.40%)。3.最常见病原体是肺炎克雷伯杆菌79例(70.54%),其次是大肠杆菌15例(13.39%)。药敏显示对第三代头孢、第四代头孢、哌拉西林他唑巴坦及单酰胺环类的耐药率达76.64%(82/107)~96.26%(103/107),对碳青霉烯类耐药率为67.86%(76/112)。4.耐碳青霉烯组比不耐碳青霉烯组死亡率高(χ^(2)=5.521,P=0.019),在单药应用时两组差异有统计学意义(χ^(2)=4.160,P=0.041),两药、3药应用时2组差异均无统计学意义(χ^(2)=0.197、0.364,P=0.657、0.546)。全因死亡因素中,死亡与合并休克、坏死性小肠结肠炎、心力衰竭、弥散性血管内凝血、耐碳青霉烯、中性粒细胞比值、尿素、胆碱酯酶、新生儿危重病评分(NCIS)相关,多因素分析发现合并新生儿期有手术指征的疾病及低NCIS是死亡的独立危险因素。结论:新生儿MDR-GNB感染的患儿死亡率高,尤其是病原菌为耐碳青霉烯类抗生素时。临床上需要采取措施减少MDR-GNB感染,同时仍需更多研究探寻有效首选抗感染方案。Objective To investigate the etiological characteristics,antibiotic regimens,treatment outcomes,and all-cause mortality factors of neonatal multidrug-resistant gram-negative bacteria(MDR-GNB)infection.Methods A retrospective cohort study was conducted to analyze the clinical data of 112 patients with MDR-GNB infection in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022.According to whether the pathogens were resistant to carbapenem antibiotics,the patients were divided into the carbapenem-resistant group and the non-carbapenem-resistant group.According to the outcome,the patients were divided into the death group and the survival group.The Chi-square test or Fisher′s exact test was used to compare the differences between groups.Results(1)A total of 112 culture-positive cases were included.The median gestational age and birth weight were 30 weeks and 1400 g,respectively,and the median age at culture-positive was 18 days.(2)A total of 131 positive samples were collected,including 67 cases(51.15%)lower respiratory tract secretion or lavage fluid samples and 49 cases(37.40%)blood samples.(3)The most common pathogen was Klebsiella pneumoniae(79 cases,70.54%),followed by Escherichia coli(15 cases,13.39%).The drug sensitivity test showed that the resistance rate to the third-generation cephalosporins,the fourth-generation cephalosporins,Piperacillin-Tazobactam,and monamide rings was 76.64%(82/107)-96.26%(103/107),and the resistance rate to carbapenems was 67.86%(76/112).(4)The mortality rate in the carbapenem-resistant group was higher than that in the non-carbapenem-resistant group(χ^(2)=5.521,P=0.019),there was significant difference between the two groups when using single drugs(χ^(2)=4.160,P=0.041),but there was no significant difference between the two groups when using two and three drugs(χ^(2)=0.197,0.364,P=0.657,0.546).Among the all-cause mortality factors,death was associated with shock,necrotizing enterocolitis,heart failure,disseminated intravascular coagulation,ca

关 键 词：婴儿 新生 多重耐药革兰阴性杆菌 产超广谱Β-内酰胺酶 耐碳青霉烯肠杆菌 

分 类 号：R722.1[医药卫生—儿科] R446.5[医药卫生—临床医学]