新生儿多重耐药菌感染危险因素及超敏C-反应蛋白与白蛋白比值的诊断价值  

Risk factors for neonatal multidrug-resistant bacterial infection and diagnostic value of hypersensitive C-reactive protein to albumin ratio

作　　者：刘庆倩 乔林霞[3] 曹亦陶 孙晓君 黄锋 Liu Qingqian;Qiao Linxia;Cao Yitao;Sun Xiaoju;Huang Feng(Department of Clinical Laboratory,The Maternity and Child Care Hospital of Kunshan,Kunshan 215300,China;Department of Clinical Laboratory,The Affiliated Kunshan People’s Hospital of Jiangsu University,Kunshan 215300,China;Neonatology Department,The Affiliated Kunshan People’s Hospital of Jiangsu University,Kunshan 215300,China;Pediatrics Department,Kunshan Second People’s Hospital,Kunshan 215300,China)

机构地区：[1]昆山市妇幼保健院检验科,昆山市215300 [2]江苏大学附属昆山医院检验科,昆山市215300 [3]江苏大学附属昆山医院新生儿科,昆山市215300 [4]昆山市第二人民医院儿科,昆山市215300

出　　处：《中华实验和临床感染病杂志(电子版)》2024年第6期335-342,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：江苏省妇幼健康科研项目(No.F201937);苏州医学重点学科项目(No.SZXK202124)。

摘　　要：目的分析新生儿重症监护病房(NICU)患儿感染多重耐药菌(MDRO)的危险因素及超敏C-反应蛋白与白蛋白比值(hs-CRP/ALB)的诊断价值。方法以2020年10月至2023年10月昆山市妇幼保健院NICU中发生MDRO感染的105例新生儿作为MDRO组,非MDRO感染的150例作为非MDRO组,收集同期150例健康新生儿为健康组。采用多因素Logistic回归分析感染MDRO的危险因素并采用受试者特征工作(ROC)曲线评价hs-CRP/ALB对新生儿感染MDRO的诊断价值。结果出生时体重(OR=2.065、95%CI:1.184~3.600、P=0.011)、Apgar评分(OR=2.470、95%CI:1.294~4.717、P=0.006)、抗菌药物使用时间(OR=2.576、95%CI:1.287~5.155、P=0.008)、深静脉置管(OR=2.751、95%CI:1.268~5.971、P=0.010)均为NICU新生儿感染MDRO的独立危险因素。与健康组相比,MDRO组患儿hs-CRP、ALB、白细胞(WBC)、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞绝对数(NEUT#)和hs-CRP/ALB在入院第1天和第3天均显著高于健康组(P均<0.05)。与非MDRO组相比,MDRO组患儿hs-CRP、ALB、WBC、NLR、NEUT#和hs-CRP/ALB入院第1天差异均无统计学意义(P均>0.05),但入院第3天hs-CRP、ALB、NLR和hs-CRP/ALB差异具有统计学意义(P均<0.05)。第3天检测hs-CRP/ALB用于区别诊断MDRO和非MDRO组新生儿的敏感性为63.09%,特异度为86.67%;与存活组相比,死亡组患儿hs-CRP、ALB、hs-CRP/ALB在入院第3天和第5天差异具有统计学意义(P均<0.05),NLR入院第5天差异有统计学意义(Z=3.878、P<0.001),NEUT#入院第3天差异有统计学意义(Z=2.533、P=0.013),而WBC入院第3天和第5天差异均无统计学意义(P均>0.05)。耐甲氧西林葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、多重耐药/泛耐药铜绿假单胞菌(MDR/PDR-PA)感染新生儿hs-CRP/ALB均>0.36;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌、耐碳青霉烯类肠杆菌科细菌(CRE)和耐碳青霉烯类鲍曼不动杆菌(CR-AB)感染的新生儿hs-CRP/ALBObjective To analyze the risk factors of multidrug-resistant bacterial(MDRO)infection in neonatal intensive care unit(NICU)and the diagnostic value of hypersensitive C-reactive protein to albumin ratio(hs-CRP/ALB).Methods Total of 105 neonates with MDRO infection in NICU of The Maternity and Child Care Hospital of Kunshan from October 2020 to October 2023 were collected as MDRO group,150 neonates without MDRO infection as non-MDRO group,and 150 healthy newborns as healthy group during the same period.The risk factors for MDRO infection were analyzed by Logistic regression analysis.The diagnostic value of hs-CRP/ALB for neonatal MDRO infection were evaluated by receiver operating curve(ROC)analysis.Results Birth weight(OR=2.065,95%CI:1.184-3.600,P=0.011),Apgar score(OR=2.470,95%CI:1.294-4.717,P=0.006),duration of antibiotic use(OR=2.576,95%CI:1.287-5.155,P=0.008),and deep venous catheterization(OR=2.751,95%CI:1.268-5.971,P=0.010)were all independent risk factors for neonatal MDRO.Compared with the healthy group,hs-CRP,ALB,white blood cell(WBC)count,neutrophil-to-lymphocyte ratio(NLR),absolute neutrophil count(NEUT#)and hs-CRP/ALB in the MDRO group were significantly higher on the first and the third day after admission(all P<0.05).Compared with non-MDRO group,there was no significant difference for hs-CRP,ALB,WBC,NLR,NEUT#and hs-CRP/ALB on the first day after admission in MDRO group(all P>0.05),but on the third day after admission,hs-CRP,ALB,NLR and hs-CRP/ALB were statistically significant(all P<0.05).On the third day,the sensitivity and specificity of hs-CRP/ALB for the diagnosis of neonates in MDRO group and non-MDRO group were 63.09%and 86.67%,respectively.Compared with the survival group,the death group showed significant differences in hs-CRP,ALB and hs-CRP/ALB on the third and the fifth day after admission(all P<0.05),NLR was significantly different on the fifth day after admission(Z=3.878,P<0.001);NEUT#was significantly different on the third day after admission(Z=2.533,P=0.013);However,there was no signif

关 键 词：新生儿重症监护病房 多重耐药菌 超敏C-反应蛋白与白蛋白比值 危险因素 

分 类 号：R722.1[医药卫生—儿科]