儿童重症监护室多重耐药菌感染情况及危险因素

Prevalence of multidrug-resistant organisms infections in pediatric intensive care unit and risk factors

目的观察南京医科大学附属儿童医院儿童重症监护室多重耐药菌感染情况,分析患儿多重耐药菌感染的危险因素。方法选择南京医科大学附属儿童医院2015年1月-2019年1月儿童重症监护室收治的1400例患儿为研究对象,设计患儿临床资料调查表,记录感染情况,分析其多重耐药菌感染病原菌分布及危险因素。结果剔除掉重复菌株后,1400例患儿共有40例多重耐药菌感染,感染率为2.86%;耐甲氧西林金黄色葡萄球菌(MRSA)检出率最高,其次依次为产超广谱β-内酰胺酶(ESBLs)大肠埃希菌、多重耐药鲍氏曼不动杆菌(MDR-AB)、ESBLs肺炎克雷伯菌等。检出标本以痰液、血液、尿液为主;多因素回归分析结果,入住ICU时间长、总住院时间长、有侵入性操作、长时间使用抗菌药物均是重症监护室患儿发生多重耐药菌感染的危险因素(OR>1,P<0.05)。结论儿童重症监护室多重耐药菌感染形势严峻,MRSA、ESBLs大肠埃希菌占主导地位,感染的发生可能与患儿长时间住院治疗、治疗期间侵入性操作等因素有关,在保证原发病治疗效果的基础上,应尽可能缩短治疗时间、减少侵入性操作及抗菌药物的使用,采取积极的防控、干预,以减少感染发生。

OBJECTIVE To observe the prevalence of multidrug-resistant organisms(MDROs)infections in pediatric intensive care unit(PICU)of the Children′s Hospital of Nanjing Medical University and analyze the distribution of pathogens and risk factors for the infections.METHODS A total of 1400 children who were treated in PICU of Children′s Hospital of Nanjing Medical University from Jan 2015 to Jan 2019 were recruited as the study objects,the questionnaire for clinical data of the children was designed,the incidence of infections was recorded,and the distribution of pathogens and the risk factors for the MDROs infections were observed.RESULTS With the repetitive strains removed,totally 40 of 1400 children had MDROs infections,with the infection rate 2.86%.The isolation rate of methicillin-resistant Staphylococcus aureus(MRSA)was the highest,followed by extended-spectrumβ-lactamases(ESBLs)-producing Escherichia coli,multidrug-resistant Acinetobacter baumannii and ESBLs-producing Klebsiella pneumoniae.The sputum,blood and urine specimens were dominant among the specimens where the pathogens were isolated.The result of multivariate regression analysis showed that long length of ICU stay,long total length of hospital stay,invasive procedures and long time use of antibiotics were the risk factors for the MDROs infections in the children of ICU(OR>1,P<0.05).CONCLUSION The MDROs infections are severe in the PICU,MRSA and ESBLs-producing E.coli are dominant among the pathogens.The incidence of the infections may be associated with the long length of hospital stay and invasive operation during treatment period.In addition to ensuring the therapeutic effect of primary diseases,it is necessary to shorten the treatment time,reduce the invasive procedures and use of antibiotics and actively take preventive interventions so as to reduce the incidence of the infections.