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

Investigation on Risk Factors and Antibiotic Resistance of Klebsiella Pneumoniae Infection in Neonates

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.