儿童重症监护病区CRE感染的危险因素及耐药情况分析

The Analysis of Risk Factors and Drug Resistance of CRE Infection in Children’s Intensive Care Unit

目的研究重症监护病区患儿CRE感染的耐药情况及发生CRE医院感染的危险因素,为儿童治疗CRE感染和医院制定感染防控策略提供参考依据。方法回顾性分析2019年1月至2022年12月入住云南省某三甲儿童医院重症监护病区患儿的临床资料,将92例耐碳青霉烯类肠杆菌科细菌(CRE)医院感染的患儿纳入病例组,按1∶1随机选择同期92例对碳青霉烯类敏感肠杆菌科细菌(CSE)感染的患儿纳入对照组,进行菌株鉴定和药敏试验,分析感染菌株和耐药情况,并通过SPSS 26.0对CRE感染患儿进行单因素和多因素Logistic回归分析,探究重症患儿发生CRE感染的相关危险因素。结果CRE感染菌株检出最多的为肺炎克雷伯菌81例(88.04%),其次为大肠埃希菌5例(5.43%)。CRE组左氧氟沙星、阿莫西林/克拉维酸、头孢他啶、亚胺培南、头孢吡肟、头孢曲松、阿米卡星耐药率均高于CSE组,均显示差异有统计学意义(P<0.05)。单因素分析结果显示,留置胃管、中心静脉置管、机械通气、碳青霉烯类、抗真菌药、糖肽类及多粘菌素类抗生素使用史、抗生素药物使用种类≥3种、抗生素药物使用时间、碳青霉烯类抗生素使用时间、入住ICU时间和总住院时间均是CRE感染的危险因素,显示差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,碳青霉烯类抗生素使用史及使用时间和抗菌药物使用时间(P<0.05)是重症患儿CRE感染的独立危险因素。结论结合重症患儿CRE感染的危险因素,尽量减少穿刺置管等侵入性操作,规范抗生素药物在重症患儿治疗中的使用管理,特别是碳青霉烯类抗生素,尽可能缩短患儿入住ICU时长和总住院时长,加强对重症患儿CRE的主动筛查,制定合理有效的感染防控策略,减少重症患儿CRE院内感染的发生。

Objective To study the drug resistance of CRE infection in children in the intensive care unit and the risk factors of nosocomial infection of CRE,and to provide the reference for the treatment of CRE infection in children and the formulation of infection prevention and control strategies in hospitals.Methods Clinical data of children admitted to the intensive care unit of a 3A Children’s Hospital in Yunnan Province from January 2019 to December 2022 were retrospectively analyzed.92 cases with nocometary infection of carbapenem-resistant enterobacteriaceae bacteria(CRE)were included in the case group,and 92 cases with carbapenem-sensitive enterobacteriaceae(CSE)infection were randomly selected at 1∶1.According to the group,strain identification and drug sensitivity test were carried out to analyze the infection strains and drug resistance.Univariate and multivariate logistic regression analysis was conducted for children with CRE infection by SPSS 26.0,to explore the risk factors related to CRE infection in severely ill children.Results Klebsiellapneumoniae was detected in 81 cases(88.04%),followed by Escherichiacoli in 5 cases(5.43%).The drug resistance rates of levofloxacin,amoxicillin/clavulanic acid,ceftazidime,imipenem,cefepime,ceftriaxoneand amikacin in CRE group were higher than those in CSE group,and the differences were statistically significant(P<0.05).Univariate analysis showed that indwelling gastric tube,central venous catheterization,mechanical ventilation,history of using carbapenems,glycopeptides and polymyxin antibiotics,types of antibiotics used≥3,time of using antibiotics,time of using carbapenems,time of staying in ICU and total hospital stay were all risk factors of CRE infection,showing statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that carbapenem antibiotic use history and use time and antibacterial use time(P<0.05)were independent risk factors for CRE infection in severely ill children.Conclusion Combined with the risk factors of severe children’s CRE infection,we should minimize invasive operations such as puncture and intubation,standardize the use and management of antibiotics in the treatment of severe children,especially carbapenem antibiotics,shorten the length of stay in ICU and the total length of stay as much as possible,strengthen the active screening of severe children’s CRE,formulate reasonable and effective infection prevention and control strategies,and reduce the occurrence of nosocomial infection of severe children’s CRE.