新生儿肺炎克雷伯杆菌感染危险因素及抗生素耐药调查研究
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摘要
目的探讨新生儿肺炎克雷伯杆菌感染危险因素及常用药物的耐药情况。方法回顾性分析2017年3月—2018年12月出生的564例新生儿的临床资料,根据新生儿的肺炎克雷伯杆菌感染情况将其分为感染组(n=32)与非感染组(n=532),比较2组性别、胎龄、出生时间、出生体重、基础疾病、重症监护室住院时间、机械通气时间、抗生素使用等。根据32例肺炎克雷伯杆菌感染新生儿的K-B纸片法药敏实验结果分析对常用药物的耐药情况。结果感染组与非感染组性别、出生时间的差异无统计学意义(P> 0. 05)。感染组胎龄<37周、出生体重<1. 5 kg、合并基础疾病、重症监护室住院时间≥7 d、机械通气时间≥3 d、联用抗生素的占比分别为43. 75%、31. 25%、28. 13%、50. 00%、43. 75%、65. 62%,显著高于非感染组的16. 92%、8. 27%、6. 77%、11. 65%、11. 47%、45. 11%(P <0. 05)。胎龄<37周、出生体重<1. 5 kg、合并基础疾病、重症监护室住院时间≥7 d、机械通气时间≥3 d为肺炎克雷伯杆菌感染的危险因素(P <0. 05)。肺炎克雷伯杆菌对氨苄西林的耐药率高达100. 00%,其次为头孢呋辛钠(53. 66%)与庆大霉素(43. 90%),对亚胺培南与美罗培南的敏感性较高。结论胎龄<37周、出生体重<1. 5kg、合并基础疾病、重症监护室住院时间≥7 d、机械通气时间≥3 d为肺炎克雷伯杆菌感染的危险因素。肺炎克雷伯杆菌对亚胺培南与美罗培南有较高敏感性,结合药敏试验基础可尽量使用上述二药进行抗感染。
Objective To explore the risk factors of Klebsiella pneumoniae infection in neonates and the drug resistance of commonly used drugs. Methods Retrospective analysis of clinical data of 564 neonates born in our hospital from March 2017 to December 2018,according to neonatal Klebsiella pneumoniae infection,divided into infected group( n = 32)and non-infected group( n = 532),The gender,gestational age,birth time,birth weight,underlying disease,hospitalization time in intensive care unit,mechanical ventilation time,antibiotic use were compared between the 2 groups. Analysis of drug resistance to commonly used drugs based on K-B paper susceptibility test results in 32 neonates infected with Klebsiella pneumoniae. Results There was no significant difference in gender and birth time between the infected group and the non-infected group( P > 0. 05). Gestational age < 37 weeks,birth weight < 1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥ 7 d,mechanical ventilation time ≥ 3 d,combined antibiotics accounted in infection group were43. 75%,31. 25%,28. 13% 50. 00%,43. 75%,and 65. 62%,significantly higher than 16. 92%,8. 27%,6. 77%,11. 65%,11. 47%,and 45. 11% of the non-infected group( P < 0. 05). The gestational age < 37 weeks,birth weight <1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥7 d,mechanical ventilation time ≥3 d were risk factors for Klebsiella pneumoniae infection( P < 0. 05). The resistance rate of Klebsiella pneumoniae to ampicillin was as high as 100. 00%,followed by 53. 66% of cefuroxime sodium and 43. 90% of gentamicin,and the sensitivity to imipenem and meropenem was higher. Conclusion Gestational age < 37 weeks,birth weight < 1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥7 d,mechanical ventilation time ≥3 d is a risk factor for Klebsiella pneumoniae infection. Klebsiella pneumoniae has high sensitivity to imipenem and meropenem. Combined with the susceptibility test,the above two drugs can be used as much as possible to fight infection.
Objective To explore the risk factors of Klebsiella pneumoniae infection in neonates and the drug resistance of commonly used drugs. Methods Retrospective analysis of clinical data of 564 neonates born in our hospital from March 2017 to December 2018,according to neonatal Klebsiella pneumoniae infection,divided into infected group( n = 32)and non-infected group( n = 532),The gender,gestational age,birth time,birth weight,underlying disease,hospitalization time in intensive care unit,mechanical ventilation time,antibiotic use were compared between the 2 groups. Analysis of drug resistance to commonly used drugs based on K-B paper susceptibility test results in 32 neonates infected with Klebsiella pneumoniae. Results There was no significant difference in gender and birth time between the infected group and the non-infected group( P > 0. 05). Gestational age < 37 weeks,birth weight < 1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥ 7 d,mechanical ventilation time ≥ 3 d,combined antibiotics accounted in infection group were43. 75%,31. 25%,28. 13% 50. 00%,43. 75%,and 65. 62%,significantly higher than 16. 92%,8. 27%,6. 77%,11. 65%,11. 47%,and 45. 11% of the non-infected group( P < 0. 05). The gestational age < 37 weeks,birth weight <1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥7 d,mechanical ventilation time ≥3 d were risk factors for Klebsiella pneumoniae infection( P < 0. 05). The resistance rate of Klebsiella pneumoniae to ampicillin was as high as 100. 00%,followed by 53. 66% of cefuroxime sodium and 43. 90% of gentamicin,and the sensitivity to imipenem and meropenem was higher. Conclusion Gestational age < 37 weeks,birth weight < 1. 5 kg,combined basic disease,intensive care unit hospitalization time ≥7 d,mechanical ventilation time ≥3 d is a risk factor for Klebsiella pneumoniae infection. Klebsiella pneumoniae has high sensitivity to imipenem and meropenem. Combined with the susceptibility test,the above two drugs can be used as much as possible to fight infection.
引文
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[15]程超,林业鑫,李玖军,等.儿童多重耐药肺炎克雷伯杆菌脓毒症感染的危险因素分析[J].中国当代儿科杂志,2015(9):932-936.
[2]陈燕玲,陈炫炜,何少茹,等.早产儿肺炎克雷伯杆菌脓毒症21例耐药性及疗效分析[J].中华实用儿科临床杂志,2016,31(21):1670-1672.
[3]杨雪,刘琳.耐碳青霉烯类肺炎克雷伯杆菌的耐药机制及治疗策略研究进展[J].医学研究生学报,2018,31(4):430-434.
[4]陈菲,沈瀚,曹小利,等.荚膜多糖在肺炎克雷伯杆菌中的研究进展[J].临床输血与检验,2018,20(3):330-332.
[5]刘琳,叶贤伟,张湘燕,等.耐碳青霉烯类肺炎克雷伯杆菌耐药机制与检测[J].临床内科杂志,2015,32(6):428-430.
[6]周静珍. 2012—2016年某医院肺炎克雷伯杆菌分布及耐药性变迁[J].中国消毒学杂志,2018,35(8):584-586.
[7]宋婷,俞蕙.耐碳青霉烯类肺炎克雷伯杆菌的感染现状及治疗进展[J].中华儿科杂志,2016,54(3):234-236.
[8]齐志丽,刘培,庄海舟,等.重症监护病房院内获得性感染的临床分析[J].首都医科大学学报,2018,39(1):41-44.
[9]查干,李瑞婷,王文,等.血培养中产超广谱β-内酰胺酶大肠埃希杆菌与肺炎克雷伯杆菌临床分布及耐药性分析[J].疑难病杂志,2017,16(3):234-238.
[10]黄健云,芮勇宇,莫和国,等.儿童肺炎克雷伯菌感染情况调查及耐药分析[J].临床儿科杂志,2015,33(1):77.
[11]李伟中,林佩贤,辜红妮,等.新生儿肺炎克雷伯菌感染及耐药分析[J].国际流行病学传染病学杂志,2014,41(2):82-85.
[12]何瑞堂,吴雪,杨越,等. NICU新生儿肺炎克雷伯菌感染的耐药分析[J].中国实验诊断学,2017,21(12):2158-2159.
[13]万小华,周治球,徐淑娟,等.新生儿病房肺炎克雷伯杆菌感染特点和耐药趋势分析[J].现代医院,2015,15(11):74-75.
[14]牛洪敏,董青,张慧慧,等.新生儿病房肺炎克雷伯菌医院感染的危险因素及防控分析[J].安徽医学,2016,37(3):309-311.
[15]程超,林业鑫,李玖军,等.儿童多重耐药肺炎克雷伯杆菌脓毒症感染的危险因素分析[J].中国当代儿科杂志,2015(9):932-936.