儿科住院患儿院内感染革兰阴性菌的危险因素和多重耐药性分析

Risk Factors and Multidrug Resistance Analysis of In-hospital Infection with Gram-negative Bacteria in Pediatric Inpatients

目的:探讨儿科住院患儿院内感染革兰阴性菌的危险因素和多重耐药性。方法:选取2018年1月-2019年6月于笔者所在医院儿科住院期间发生革兰阴性菌感染的80例患儿进行回顾性分析,设置为研究组;选取同期非革兰阴性菌感染患儿80例为对照组。收集患儿的临床资料,根据细菌培养、药敏试验结果及Logistics回归分析,对院内感染革兰阴性菌及多重耐药性的危险因素进行分析。结果:研究组中年龄1~4岁、营养不良、先天性心脏病、遗传代谢病、不合理使用抗生素、住院时间≥7 d、上呼吸道感染、消化道感染及下呼吸道感染比例均高于对照组,差异均有统计学意义(P<0.05);患儿年龄、基础疾病、不合理使用抗生素、住院时间、感染均属于院内感染革兰阴性菌的危险因素。80例革兰阴性菌感染患儿中有44例为多重耐药,其中鲍曼不动杆菌26例(59.09%),大肠埃希氏菌16例(36.36%);多重耐药性患儿中年龄1~4岁、住院时间≥7 d、不合理使用抗生素比例均高于非多重耐药性患儿,差异均有统计学意义(P<0.05);患儿年龄、不合理使用抗生素、住院时间均为多重耐药性的危险因素。结论:临床上应合理选用抗菌药物,控制多重耐药菌产生,减少儿科住院患儿院内感染事件。

Objective:To investigate the risk factors and multidrug resistance of in-hospital infection with Gram-negative bacteria in pediatric inpatients.Method:From January 2018 to June 2019,80 children with Gram-negative bacterial infection in the department of pediatric of our hospital were retrospectively analyzed,set as the study group,and 80 children with non-Gram-negative bacterial infection were selected as the control group at the same time.The clinical data of the children were collected,and the risk factors of in-hospital infection with Gram-negative bacteria and multidrug resistance were analyzed according to the results of bacterial culture,drug sensitivity test and Logistic regression analysis.Result:In the study group,the proportions of the age was 1 to 4 years old,malnutrition,congenital heart disease,genetic metabolic disease,unreasonable use of antibiotics,hospitalization time≥7 days,upper respiratory tract infection,digestive tract infection and lower respiratory tract infection were all higher than those of the control group,and the differences were statistically significant(P<0.05).Age,underlying disease,unreasonable use of antibiotics,hospitalization time and infection were all risk factors of in-hospital infection with Gram-negative bacteria.Among the 80 children infected with Gram-negative bacteria,44 were multidrug resistance,including 26 cases(59.09%)with acinetobacter baumannii and 16 cases(36.36%)with escherichia coli.Among the children with multidrug resistance,the proportions of the age was 1 to 4 years old,hospitalization time≥7 days and the unreasonable use of antibiotics were higher than those of the children without multidrug resistance,and the differences were statistically significant(P<0.05).Age,unreasonable use of antibiotics,hospitalization time were all risk factors of multidrug resistance.Conclusion:We should reasonably choose antimicrobial drugs to control the production of multidrug resistant bacteria and reduce the incidenceof in-hospital infection in pediatric hospitalized children.