NICU产ESBL肺炎克雷伯菌感染危险因素分析

Analysis of Risk Factors of ESBL Positive Klebsiella Pneumoniae in NICU

目的分析新生儿重症监护室(NICU)产超广谱内酰胺酶(ESBL)肺炎克雷伯菌感染危险因素,为预防ESBL阳性肺炎克雷伯菌所致感染和临床治疗提供参考依据。方法回顾性收集2014年1月-2018年12月期间江门市某院NICU 121例患儿病历资料。分析肺炎克雷伯菌耐药率,并应用单因素及多因素Logistic回归方法对ESBL阳性肺炎克雷伯菌感染危险因素进行分析。结果 ESBL阳性肺炎克雷伯菌对氨苄西林、头孢唑啉、头孢噻肟耐药率最高,为100%;除美罗培南、厄他培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦以外,ESBL阳性肺炎克雷伯菌对其余抗菌药物耐药率均高于ESBL阴性菌株(P <0.05)。经单因素和多因素logistics回归分析,孕周、头孢菌素的使用是NICU感染ESBL阳性肺炎克雷伯菌的独立危险因素(P <0.05)。结论 NICU治疗ESBL阳性肺炎克雷伯菌可首选碳青霉烯类药物治疗。延长孕周和控制头孢菌素的使用可以减少感染ESBL阳性肺炎克雷伯菌的可能性。

Objective To study the clinical risk factors of Klebsiella pneumonia with producing extended-spectrum-lactamase(ESBL) in Neonatal Intensive Care Unit(NICU),so as to provide references for the prevention of ESBL-positive Klebsiella pneumoniae and clinical treatment. Methods Medical records of 121 inpatients of NICU in a hospital of Jiangmen were collected retrospectively from January 2014 to December 2018. The drug resistance rate of Klebsiella pneumoniae was analyzed, and the risk factors of ESBL-positive klebsiella pneumoniae infection were analyzed by univariate and multivariate Logistic regression. Results The drug resistance rate of esbl-positive klebsiella pneumoniae to ampicillin, cefazolin and cefotaxime was the highest(100%).Except for meropenem, ertapenem, imipenem, amikacin, piperacillin/tazobactam, the resistance rate of ESBL positive klebsiella pneumoniae to other antimicrobial agents was higher than that of ESBL negative strains(P<0.05). Univariate and multivariate logistic regression analysis showed that gestation week and the use of cephalosporin were independent risk factors for NICU infection with esbl-positive klebsiella pneumoniae(P<0.05). Conclusion Carbapenems can be the first choice for treatment of ESBL positive klebsiella pneumoniae in NICU. And prolonging gestation and controlling of cephalosporin use can reduce the possibility of infection with esbl-positive klebsiella pneumoniae.