NICU新生儿多药耐药菌感染危险因素分析

Distribution of multidrug-resistant organism infections in neonates of NICU and risk factors

目的探讨新生儿重症监护病房(NICU)多药耐药菌(MDROs)感染的分布特点及危险因素,研究其预防策略,为临床合理使用抗菌药物提供科学依据。方法分析2011-2013年入住NICU感染疾病区新生儿171例MDROs的来源、分布、构成比及耐药率,另外在该区按是否感染MDROs随机选取164例新生儿作为观察组和对照组,每组各82例;采用SPSS20.0软件进行统计分析。结果 247株MDROs 68.42%来源于NICU内,社区来源仅为7.29%;革兰阴性菌占79.35%,革兰阳性菌占20.65%,排前3位病原菌依次为铜绿假单胞菌、鲍氏不动杆菌和肺炎克雷伯菌;感染部位以呼吸道居首位,占40.89%;对氨苄西林、头孢唑林和哌拉西林普遍耐药,耐药率分别为100.00%、100.00%和92.62%;低出生体重儿、机械通气、应用抗菌药物>7d、脐静脉置管、危重程度<70分、窒息、羊膜早破、早产、置胃管、PICC和住院>14d等11个因素与MDROs密切相关,其中低出生体重儿、机械通气、抗菌药物应用>7d、脐静脉置管和PICC等5个因素是独立危险因素。结论加强细菌耐药监测与管理、指导临床合理用药、减少侵入性操作和缩短疗程是降低NICU新生儿MDROs感染率的关键。

OBJECTIVE To investigate the distribution of multidrug-resistant organism（MDRO）infections in neonatal intensive care untie（NICU）,analyze the risk factors,and put forward the prevention strategies so as to provide scientific basis for reasonable clinical use of antibiotics.METHODS A total of 171 children who were hospitalized the infectious diseases wards of NICU from 2011 to 2013were enrolled in the study,then the sources,distribution,constituent ratio,and drug resistance rates of the MDROs were observed,164 neonates were randomly chosen as the observation group and the control group according to the status of MDRO infections,with 82 cases in each,and the statistical analysis was performed with the use of SPSS20.0software.RESULTS Of 247 strains of MDRO,68.42% were isolated from the NICU,and only 7.29% were isolated from the community;79.35%were the gram-negative bacteria,and 20.65% were the gram-positive bacteria;the Pseudomonas aeruginosa,Acinetobacter baumannii,and Klebsiella pneumoniae ranked the top three species.The respiratory tract ranked the first place of infection sites,accounting for 40.89%.The drug resistance rates to ampicillin,cefazolin,and piperacillin were 100.00%,100.00%,and 92.62%,respectively.The MDROs infection were closely related to 11 factors,including low birth weight,mechanical ventilation,use of antibiotics more than 7days,umbilical venous catheterization,score of critical degree less than 70 points,asphyxia,premature rupture of membrane,premature delivery,gastric intubation,PICC,and hospitalization duration more than 14days;the 5independent risk factors included the low birth weight,mechanical ventilation,use of antibiotics more than 7days,umbilical venous catheterization,and PICC.CONCLUSIONIt is the key to strengthen the surveillance and management of the drug resistance to guide the reasonable clinical use of antibiotics,reduce the invasive operations,and shorten the treatment course so as to reduce the incidence of MDROs infections in the neonates of NICU.