新生儿肺炎克雷伯菌医院感染预后相关因素分析
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摘要
目的探讨新生儿肺炎克雷伯菌(KPN)医院感染患者预后相关危险因素,为临床治疗和预防提供依据。方法回顾性的分析2014年-2017年医院109例KPN感染新生儿的病例资料,其中死亡组20例,生存组89例,分别统计感染部位及耐药情况。预后相关单因素分析采用成组t检验或卡方检验,多因素分析采用Logistic回归分析法,生存分析采用Kaplan-Meier法。结果死亡组和生存组均以下呼吸道感染为主;大部分抗菌药物的耐药率死亡组要比生存组高;单因素分析结果显示产妇胎膜早破史、胎龄、出生体质量、CRKP感染、PICC置管史、碳青霉烯类药物使用史是新生儿KPN感染后死亡的相关危险因素;多因素分析结果显示仅CRKP感染是新生儿KPN感染后死亡的独立危险因素,OR值为4.853(95%CI:1.617～14.561);生存分析显示CRKP组患儿的30 d死亡率明显高于CSKP组(P=0.004)。结论 CRKP感染是新生儿KPN感染后死亡的独立危险因素,应对高危患儿加强防控。
OBJECTIVE To explore the related risk factors for prognosis of the neonates with Klebsiella pneumoniae nosocomial infection so as to provide guidance for clinical prevention and treatment. METHODS Totally 109 neonates with K.pneumoniae infection who were treated in hospitals from 2014 to 201 were enrolled in the study and divided into the death group with 20 cases and the survival group with 89 cases, the clinical data of the neonates were retrospectively analyzed. The infection sites and drug resistance rates were statistically analyzed. Univariate analysis of the prognosis was performed by means of group t-test or chi-square test, the multivariate logistic regression analysis was carried out, and the survival analysis was performed with the use of Kaplan-Meier method. RESULTS The neonates with lower respiratory tract infection were dominant in both the death group and the survival group. The drug resistance rates to most of the antibiotics were higher in the death group than in the survival group. The univariate analysis showed that the premature rupture of fetal membranes, gestational age, birth weight, CRKP infection, history of PICC and use of carbapenems were the related risk factors for death of the neonates with K.pneumoniae infection. The multivariate analysis indicated that only the CRKP infection was the independent risk factor for death of the neonates with K.pneumoniae infection, with the OR value 4.853(95%CI:1.617～14.561). The survival analysis showed that the 30-day mortality rate of the CRKP group was significantly higher than that of the CSKP group( P=0.004). CONCLUSION The CRKP infection is the independent risk factor for death of the neonates with K.pneumoniae infection, and it is necessary to boost the control and prevention for the high-risk neonates.
OBJECTIVE To explore the related risk factors for prognosis of the neonates with Klebsiella pneumoniae nosocomial infection so as to provide guidance for clinical prevention and treatment. METHODS Totally 109 neonates with K.pneumoniae infection who were treated in hospitals from 2014 to 201 were enrolled in the study and divided into the death group with 20 cases and the survival group with 89 cases, the clinical data of the neonates were retrospectively analyzed. The infection sites and drug resistance rates were statistically analyzed. Univariate analysis of the prognosis was performed by means of group t-test or chi-square test, the multivariate logistic regression analysis was carried out, and the survival analysis was performed with the use of Kaplan-Meier method. RESULTS The neonates with lower respiratory tract infection were dominant in both the death group and the survival group. The drug resistance rates to most of the antibiotics were higher in the death group than in the survival group. The univariate analysis showed that the premature rupture of fetal membranes, gestational age, birth weight, CRKP infection, history of PICC and use of carbapenems were the related risk factors for death of the neonates with K.pneumoniae infection. The multivariate analysis indicated that only the CRKP infection was the independent risk factor for death of the neonates with K.pneumoniae infection, with the OR value 4.853(95%CI:1.617～14.561). The survival analysis showed that the 30-day mortality rate of the CRKP group was significantly higher than that of the CSKP group( P=0.004). CONCLUSION The CRKP infection is the independent risk factor for death of the neonates with K.pneumoniae infection, and it is necessary to boost the control and prevention for the high-risk neonates.
引文
[1] Folgori L,Bielicki J,Heath PT,et al.Antimicrobial-resistant gram-negative infections in neonates:burden of disease and challengesin treatment[J].Curr Opin Infect Dis,2017,30(3):281-288.
[2] Li X,Ding X,Shi P,et al.Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital,2013 to 2017[J].Medicine (Baltimore),2019,98(12):e14686.
[3] Mutlu M,Aslan Y,Akturk Acar F,et al.Changing trend of microbiologic profile and antibiotic susceptibility of the microorganisms isolated in the neonatal nosocomial sepsis:a 14 years analysis[J].J Matern Fetal Neonatal Med,2019,4:1-8.
[4] Guo J,Luo Y,Wu Y,et al.Clinical characteristic and pathogen spectrum of neonatal sepsis in Guangzhou city from June 2011 to June 2017[J].Med Sci Monit,2019,25:2296-2304.
[5] 吴夏萍,郭少青,钟美珍,等.早产儿感染耐美罗培南肺炎克雷伯菌的危险因素分析[J].中华医院感染学杂志,2016,26(4):925-927.
[6] Ahmad N,Ali SM,Khan AU.Molecular characterization of novel sequence type of carbapenem-resistant New Delhi metallo-β-lactamase-1-producing Klebsiella pneumoniae in the neonatal intensive care unit of an Indian hospital[J].Int J Antimicrob Agents,2019,53(4):525-529.
[7] Gomez-Simmonds A,Nelson B,Eiras DP,et al.Combination regimens for treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infections[J].Antimicrob Agents Chemother,2016,60(6):3601-3607.
[8] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[9] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].24th informational supplement,2014,M100-S24.
[10] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[11] Jin Y,Shao C,Li J,et al.Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province,China[J].PLoS One,2015,10(3):e0119571.
[12] 肖婷婷,喻玮,牛天水,等.ICU患者碳青霉烯类不敏感肺炎克雷伯菌血流感染危险因素及预后分析[J].中国抗生素杂志,2017,42(12):1090-1096.
[13] Falagas ME,Tansarli GS,Karageorgopoulos DE,et al.Deaths attributable to carbapenem-resistant Enterobacteriaceae infections[J].Emerg Infect Dis,2014,20(7):1170-1175.
[14] 谭莉,凃敏,彭威军,等.新生儿耐碳青霉烯类肺炎克雷伯菌医院感染相关因素分析[J].中华医院感染学杂志,2018,28(18):2811-2814.
[15] Pope JL,Yang Y,Newsome RC,et al.Microbial colonization coordinates the pathogenesis of a Klebsiella pneumoniae infant isolate[J].Sci Rep,2019,9(1):3380.
[16] Prakobsrikul N,Malathum K,Santanirand P,et al.Correlation between antimicrobial consumption and the prevalence of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae at a university hospital in Thailand[J].J Clin Pharm Ther,2019,44(2):292-299.
[17] Giannella M,Pascale R,Gutierrez-Gutierrez B,et al.The use of predictive scores in the management of patients with carbapenem-resistantKlebsiella pneumoniae infection[J].Expert Rev Anti Infect Ther,2019,17(4):265-273.
[18] Legeay C,Bourigault C,Lepelletier D,et al.Prevention of healthcare-associated infections in neonates:room for improvement[J].J Hosp Infect,2015,89(4):319-323.
[2] Li X,Ding X,Shi P,et al.Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital,2013 to 2017[J].Medicine (Baltimore),2019,98(12):e14686.
[3] Mutlu M,Aslan Y,Akturk Acar F,et al.Changing trend of microbiologic profile and antibiotic susceptibility of the microorganisms isolated in the neonatal nosocomial sepsis:a 14 years analysis[J].J Matern Fetal Neonatal Med,2019,4:1-8.
[4] Guo J,Luo Y,Wu Y,et al.Clinical characteristic and pathogen spectrum of neonatal sepsis in Guangzhou city from June 2011 to June 2017[J].Med Sci Monit,2019,25:2296-2304.
[5] 吴夏萍,郭少青,钟美珍,等.早产儿感染耐美罗培南肺炎克雷伯菌的危险因素分析[J].中华医院感染学杂志,2016,26(4):925-927.
[6] Ahmad N,Ali SM,Khan AU.Molecular characterization of novel sequence type of carbapenem-resistant New Delhi metallo-β-lactamase-1-producing Klebsiella pneumoniae in the neonatal intensive care unit of an Indian hospital[J].Int J Antimicrob Agents,2019,53(4):525-529.
[7] Gomez-Simmonds A,Nelson B,Eiras DP,et al.Combination regimens for treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infections[J].Antimicrob Agents Chemother,2016,60(6):3601-3607.
[8] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[9] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].24th informational supplement,2014,M100-S24.
[10] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[11] Jin Y,Shao C,Li J,et al.Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province,China[J].PLoS One,2015,10(3):e0119571.
[12] 肖婷婷,喻玮,牛天水,等.ICU患者碳青霉烯类不敏感肺炎克雷伯菌血流感染危险因素及预后分析[J].中国抗生素杂志,2017,42(12):1090-1096.
[13] Falagas ME,Tansarli GS,Karageorgopoulos DE,et al.Deaths attributable to carbapenem-resistant Enterobacteriaceae infections[J].Emerg Infect Dis,2014,20(7):1170-1175.
[14] 谭莉,凃敏,彭威军,等.新生儿耐碳青霉烯类肺炎克雷伯菌医院感染相关因素分析[J].中华医院感染学杂志,2018,28(18):2811-2814.
[15] Pope JL,Yang Y,Newsome RC,et al.Microbial colonization coordinates the pathogenesis of a Klebsiella pneumoniae infant isolate[J].Sci Rep,2019,9(1):3380.
[16] Prakobsrikul N,Malathum K,Santanirand P,et al.Correlation between antimicrobial consumption and the prevalence of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae at a university hospital in Thailand[J].J Clin Pharm Ther,2019,44(2):292-299.
[17] Giannella M,Pascale R,Gutierrez-Gutierrez B,et al.The use of predictive scores in the management of patients with carbapenem-resistantKlebsiella pneumoniae infection[J].Expert Rev Anti Infect Ther,2019,17(4):265-273.
[18] Legeay C,Bourigault C,Lepelletier D,et al.Prevention of healthcare-associated infections in neonates:room for improvement[J].J Hosp Infect,2015,89(4):319-323.