儿童大肠埃希菌医院感染流行特征及影响因素分析

Epidemiological characteristics and influencing factors of nosocomial Escherichia coli infection in children

目的分析儿童大肠埃希菌(E.coli)医院感染流行病学特征及产ESBLs E.coli感染的危险因素,为更好地预防儿童E.coli医院感染提供科学依据。方法采用随机抽样法选邯郸地区二级以上医院2020年1月至2021年12月住院的院内感染患儿169例,采集标本后,采用VITEK-32鉴定系统鉴定细菌,采用全自动药敏分析仪Phoenix 100对分离出的大肠埃希菌纯菌落进行药敏鉴定,统计分析大肠埃希菌的耐药性。由经过统一培训的专业人员从病例系统中调取患儿临床资料,统计所有患儿的科室分布、基础疾病、临床特征、抗生素耐药、住院天数、手术、侵入性操等临床资料,采用多因素logistic回归分析院内患儿发生ESBLs大肠埃希菌医院感染的危险因素。结果住院儿童医院感染患儿中检出大肠埃希菌39株,主要标本为痰22株(56.41%)、尿液11株(28.21%)、血液6株(15.38%);ESBLs大肠埃希菌检出21株,阳性率为53.85%;发热为最常见首发症状,共37例(94.87%);ESBLs(+)大肠埃希菌感染患儿在年龄、住院天数、新生儿/近期使用广谱抗生素、合并基础疾病、侵入性操作间比例显著高于ESBLs(-)大肠埃希菌患儿(P<0.05);多因素logistic回归分析结果显示近期使用抗生素、合并基础疾病、侵入性操作是院内患儿发生ESBLs E.coli感染的独立危险因素(P<0.05);结论儿童E.coli医院感染的发生率较高,对于近期使用抗生素、合并基础疾病、侵入性操作的患儿应积极进行干预,可降低ESBLs E.coli感染的风险。

Objective To analyze the epidemiological characteristics of nosocomial Escherichia coli infection and risk factors of ESBLs-producing Escherichia coli infection in children,and to provide scientific basis for better prevention of nosocomial Escherichia coli infection in children.Methods A total of 169 children with nosocomial infection hospitalized in Handan Regional Children′s Hospital from January 2020 to December 2020 were selected by random sampling method.After specimen collection,bacteria were identified by VitEK-32 identification system,and drug sensitivity of isolated pure Escherichia coli colony was identified by automatic drug sensitivity analyzer Phoenix 100.Statistical analysis of drug resistance of Escherichia coli.The clinical data of the children were retrieved from the case system by uniformly trained professionals,and the department distribution,underlying diseases,clinical characteristics,antibiotic resistance,length of hospital stay,surgery,invasive exercises and other clinical data of all the children were counted.Factor logistic regression analysis of the risk factors of nosocomial infection of ESBLs Escherichia coli in children in the hospital.Results A among of 39 strains of Escherichia coli were detected in children with nosocomial infection in children′s hospital.The main specimens were 22 strains(56.41%)in sputum,11 strains(28.21%)in urine and 6 strains(15.38%)in blood.Twenty-one strains of ESBLs Escherichia coli were detected,with a positive rate of 53.85%.Fever was the most common first symptom in 37 cases(94.87%).Children with ESBLs(+)Escherichia coli infection were significantly higher than those with ESBLs(-)Escherichia coli in age,length of hospitalization,neonates/recent use of broad-spectrum antibiotics,complicated underlying diseases,and invasive operation(P<0.05).Multivariate logistic regression analysis showed that recent use of antibiotics,combined with underlying diseases,and invasive operation were independent risk factors for ESBLs infection in children in hospital(P<0.05).Conclusion The incidence of nosocomial Escherichia coli infection in children is high,and active intervention should be carried out for children who have recently used antibiotics,complicated with underlying diseases,and invasive operations to reduce the risk of ESBLs Escherichia coli infection.