新生儿多重耐药性肺炎病原菌的耐药性及相关危险因素分析

Investigation of the drug resistance of multidrug-resistant bacterial pneumonia in newborns and an analysis of related risk factors

目的探讨新生儿多重耐药性肺炎病原菌的耐药性及多重耐药菌肺炎发生的相关危险因素。方法选取2019年1月-2020年1月经本院新生儿科确诊为多重耐药菌肺炎患者30例(多重耐药组),另选取同期新生儿病房收治的非多重耐药菌肺炎患者(非多重耐药组)50例作为对照。分析多重耐药组患儿呼吸道分泌物多重耐药菌检出情况及其药敏试验结果;应用单因素及多因素Logistic回归分析法分析新生儿多重耐药菌肺炎发生的危险因素。结果多重耐药组患儿呼吸道分泌物共检出多重耐药菌30株,均为单一多重耐药菌,以产超广谱β-内酰胺霉(ESBLs)肺炎克雷伯菌(12/30,40.00%)多见,其次为产ESBLs大肠埃希菌(9/30,30.00%)。药敏试验显示多重耐药肺炎克雷伯菌和大肠埃希菌对青霉素和头孢类不同程度耐药;对亚胺培南、美罗培南、阿米卡星敏感,耐药率均为0。经多因素Logistic回归分析,早产、低出生体质量(<2500g)、羊水污染、住院时间>14d、连续应用抗菌药物(>7d)、机械通气是新生儿多重耐药菌肺炎发生的独立危险因素(P<0.05)。结论新生儿多重耐药性肺炎的主要病原菌为肺炎克雷伯菌和大肠埃希菌,早产、低出生体质量、羊水污染、连续应用抗菌药物是新生儿发生多重耐药菌肺炎的独立危险因素。因此应采取有效防治措施,合理应用抗生素,减少新生儿多重耐药菌肺炎的发生。

Objectives To investigate the drug resistance of pathogens causing multidrug-resistant(MDR)pneumonia in newborns,and to analyze the related risk factors for MDR pneumonia.Methods Subjects,were 30 newborns with MDR pneumonia seen at this Hospital from January 2019 to January 2020.In addition,50 newborns with out MDR pneumonia seen in the neonatal ward during the same period served as the control group.MDR bacteria were detected in respiratory secretions from newborns with pneumonia,and a drug sensitivity test was performed.Univariate and multivariate logistic regression analysis were used to analyze the risk factors for MDR pneumonia in newborns.Results Thirty strains of MDR bacteria were detected in respiratory tract secretions from patients with MDR pneumonia,and each patient was infected with a single strain.ESBLs-producing Klebsiella pneumoniae(12/30,40.00%)was the most common,followed by ESBLs-producing Escherichia coli(9/30,30.00%).The drug sensitivity test indicated that MDR K.pneumoniae and E.coli were resistant to penicillin and cephalosporins,and sensitive to imipenem,meropenem,and amikacin,with a resistance of 0.00%.Multivariate logistic regression analysis indicated that premature delivery,a low birth weight(<2500 g),contamination of the amniotic fluid,a duration of hospitalization>14 days,continuous use of antibiotics(>7 days),and mechanical ventilation were independent risk factors for MDR pneumonia in newborns(P<0.05).Conclusion K.pneumoniae and E.coli are the main pathogens causing MDR pneumonia in newborns.Premature delivery,a low birth weight,contamination of the amniotic fluid,and continuous use of antibiotics are independent risk factors for MDR pneumonia in newborns.Therefore,effective prevention and control measures should be implemented and antibiotics should be used rationally to,reduce the incidence of MDR bacterial pneumonia in newborns.