耳鼻咽喉疾病患儿多药耐药菌感染现状及影响因素

Current status and influencing factors for multidrug-resistant organisms infections in children with otorhinolaryngologic diseases

目的调查分析耳鼻咽喉疾病患儿多药耐药菌(MDROs)感染现状及影响因素。方法回顾性分析2015年9月-2019年9月江西省九江市妇幼保健院耳鼻喉科收治的206例耳鼻咽喉疾病患儿临床资料,采集患儿标本(包含耳内、鼻、咽喉等处分泌物)行病原菌检测和药敏试验,依据是否出现MDROs感染分为MDROs感染组、非MDROs感染组,分析206例患儿MDROs感染现状和病原菌分布情况及MDROs感染的影响因素。结果共分离病原菌186株,48例患儿检出MDROs(共50株),MDROs感染率26.88%(50/186)。2015年-2019年耳鼻咽喉疾病患儿MDROs感染率逐年递增。患儿MDROs感染病原菌以产超广谱β内酰胺酶肠杆菌科细菌(30.00%)、泛耐药铜绿假单胞菌(28.00%)、耐甲氧西林金黄色葡萄球菌(26.00%)较为常见。MDROs感染组病程>5年、出现急性感染期频次≥3次/年、抗菌药物使用种类≥3种占比高于非MDROs感染组(P<0.05)。病程、出现急性感染期频次、抗菌药物使用种类、不规律用药次数为耳鼻咽喉疾病患儿MDROs感染的高危因素(P<0.05)。结论耳鼻咽喉疾病患儿MDROs感染风险高,临床需加强对病程长、急性感染期频次高患儿的重视,而规范使用抗菌药物、提高规律用药积极性,对降低MDROs感染风险有重要临床意义。

OBJECTIVE To investigate the current status and influencing factors for multidrug-resistant organisms(MDROs) infections in children with otorhinolaryngologic diseases. METHODS Totally 206 children with otorhinolaryngologic diseases who were treated in Jiujiang Maternal and Child Health Hospital from Sep 2015 to Sep 2019 were enrolled in the study, the clinical data of the children were retrospectively analyzed. The specimens, including ear, nose and throat secreta, were collected from the children for culture of pathogens, the drug susceptibility testing was carried out, the children were divided into the MDROs infection group and the non-MDROs infection group according to the status of MDROs infection. The current status of MDROs infections in the 206 children, distribution of pathogens and influencing factors for MDROs infections were observed. RESULTS A total of 186 strains of pathogens were isolated, 50 strains of MDROs were isolated from 48 children, and the incidence rate of MDROs infection was 26.88%(50/186). The incidence rate of MDROs infection of the children with otorhinolaryngologic diseases was increased year by year from 2015 to 2019. Among the pathogens causing MDROs infection in the children, extended-spectrum β-lactamases-producing Enterobacteriaceae accounted for 30.00%, pandrug-resistant Pseudomonas aeruginosa accounted for 28.00%, and methicillin-resistant Staphylococcus aureus accounted for 26.00%. The proportions of the children with course of diseases more than 5 years, frequency of attach of acute infection no less than 3 times a year and use of antibiotics no less than 3 types were significantly higher in the MDROs infection group than in the non-MDROs infection group(P<0.05). The course of disease, frequency of attack of acute infection, types of antibiotic and number of times of irregular medication were the high risk factors for the MDROs infection in the children with otorhinolaryngologic diseases(P<0.05). CONCLUSION The children with otorhinolaryngologic diseases are at high risk of MDROs infection. It is necessary to pay attention to the children with long course of disease and high frequency of acute infection. Standardized use of antibiotics and improvement of initiative of regular medication have significant clinical significance in reducing the risk of MDROs infection.