新生儿重症监护室产超广谱β-内酰胺酶菌院内感染危险因素及耐药性分析

Risk factors and resistance for neonatal nosocomial infection with extended spectrum β-lactamase producing bacteria in NICU

目的 分析新生儿重症监护室 (NICU)新生儿产超广谱 β 内酰胺酶 (ESBLs)菌感染危险因素、菌株耐药性及临床特征。方法 选择 2 0 0 0年 1月至 2 0 0 3年 1月中山大学第一医院NICU病原菌培养阳性新生儿院内感染共 88例 ,比较 2 2例 (2 8株 )ESBL阳性和 17例 (17株 )ESBL阴性患儿日龄、性别、孕周、体重、感染发生时间、感染部位、原发病、菌株耐药性、抗生素及侵入性操作使用情况。结果 单因素分析和多因素Logistic回归均显示早产低出生体重儿、机械通气时间≥ 7d和先期使用 3代头孢菌素均为产ESBL菌感染的独立危险因素 (P <0 0 5 ) ,而入院到分离出致病菌天数、气管插管、先期使用 β 内酰胺酶抑制剂及中心静脉插管等因素没有统计学意义 (P >0 0 5 )。药敏试验显示亚胺培南、哌拉西林 /他唑巴坦和头孢哌酮 /舒巴坦对ESBL(+)菌有较高活性。结论 早产低出生体重儿、长时间机械通气和先期使用 3代头孢菌素是新生儿产ESBL菌感染的危险因素。治疗产ESBL菌所致的新生儿严重院内感染 。

Objective To study risk factors,resistance and clinical characteristics of neonatal nosocomial infection caused by extended spectrum β lactamase(ESBL) producing bacteria in Neonatal Intensive Care Unit(NICU).Methods Eighty eight neonates with culture positive nosocomial infection in recent 3 years were enrolled in the study.Twenty two neonates infected with ESBL producing bacteria were compared to 17 non ESBL producing strains in term of age,sex,gestational age,body weight,time and site of infection,underlying disease,resistance,antibiotics and invasive manipulations used.Results Both univariate and multivariate logistic regression analysis revealed that preterm and low birth weight,prolonged mechanical ventilation(≥7 days) and prior use of third generation cephalosporins were independent risks factors for infection with ESBL producing organism(P<0.05).Other factors including isolation time,intubation,prior use of β lactamase inhibitor and central venous catheter use were not statistically significant(P>0.05).Anti microbial sensitivity test showed that ESBL producing strains appeared susceptible to Imipenem,piperacillin/tazobactam and cefoperazone/sulbactam.Conclusion Preterm low birth weight,prolonged mechanical ventilation and prior use of third generation cephalosporins are risks factors for infection with ESBL producing bacteria.Imipenem can be chosen as empirical antibiotics for severe neonatal nosocomial infection caused by ESBL producing bacteria.