儿童耐碳青霉烯类鲍曼不动杆菌的感染分布和耐药情况及其危险因素分析

Distribution and risk factors of carbapenem-resistant Acinetobacter baumannii infection in 62 children

目的分析儿童耐碳青霉烯类鲍曼不动杆菌(CRAB)的感染分布和耐药情况,并探究其感染的危险因素。方法回顾性分析2015年1月至2021年12月郑州大学附属儿童医院收治的62例CRAB感染患儿的临床资料(病例组),另选取同期未感染CRAB的儿科患儿62例作为对照组,分析病例组患儿CRAB感染的分布情况和耐药情况,比较两组患儿的临床资料,并采用Logistics回归模型分析儿童感染CRAB的危险因素。结果62例患儿中以<1岁为主,占67.74%,以男童为主,占70.97%,以医院感染为主,占67.74%,标本主要来源分布于ICU,占66.13%。药敏试验结果显示,分离出的62株CRAB对氨曲南天然耐药,且耐药率最高,为100.00%,其次是哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、亚胺培南、美罗培南,耐药率均为67.74%;对阿米卡星和复方新诺明较为敏感,耐药率分别为41.94%、46.77%。两组患儿的性别、住院时间、基础疾病、并发症、有创穿刺及引流、支气管镜、C反应蛋白(CRP)、降钙素原(PCT)比较差异均无统计学意义(P>0.05);病例组患儿的年龄明显低于对照组,碳青霉烯类抗生素暴露、中心静脉置管、机械通气、留置尿导管、WBC、NEU则明显高于对照组,差异均有统计学意义(P<0.05)。Logistic回归模型分析结果显示,碳青霉烯类抗生素暴露、中心静脉置管、机械通气、留置尿导管、白细胞计数(WBC)、中性粒细胞计数(NEU)均是儿童CRAB感染的独立危险因素(P<0.05)。结论本院CRAB感染患儿以医院感染为主,并且主要来自ICU,表现为多重耐药和泛耐药。碳青霉烯类抗生素暴露、中心静脉置管、机械通气、留置尿导管、WBC、NEU均是儿童CRAB感染的独立危险因素。

Objective To analyze the distribution and drug resistance of carbapenem-resistant Acinetobacter baumannii(CRAB)in children with infection and to explore the risk factors of infection.Methods The clinical data of 62 children with CRAB infection admitted to Children's Hospital Affiliated to Zhengzhou University from January 2015 to December 2021(the study group)were retrospectively analyzed.Another 62 children in the Department of Pediatrics who were not infected with CRAB during the same period were selected as the control group.The distribution and drug resistance of CRAB infection in the study group were analyzed,and clinical data of the two groups were compared.Logistics regression model was used to analyze the risk factors of CRAB infection in children.Results Among the 62 patients,most were under 1 year old(accounting for 67.74%),boys(70.97%),and had hospital infections(67.74%),and the main source of specimens was ICU(66.13%).The results of drug sensitivity test showed that 62 CRAB strains isolated were naturally resistant to aztreonam,and the resistance rate was the highest(100.00%),followed by piperacillin,piperacillin/tazobactam,cefepime,imipenem,and meropenem,with resistance rates of 67.74%each.The strains were relatively sensitive to amikacin and cotrimoxazole,with resistance rates of 41.94%and 46.77%,respectively.There were no significant differences in gender,length of hospital stay,underlying diseases,complications,invasive puncture and drainage,bronchoscopy,C-reactive protein(CRP),and procalcitonin(PCT)between the two groups(P>0.05).The age of the children in the study group was significantly younger than that in the control group,while the exposure to carbapenem antibiotics,central venous catheterization,mechanical ventilation,indwelling urinary catheter,white blood cell(WBC),and neutrophil(NEU)were significantly higher than those in the control group,with statistically significant differences(P<0.05).Logistic regression model analysis showed that exposure to carbapenem antibiotics,central venous catheterization,mechanical ventilation,indwelling urinary catheter,WBC,and NEU were all independent risk factors for CRAB infection in children (P<0.05). Conclusion The CRAB infection in children in the hospital is mainly hospital infectionand mainly from ICU, showing multidrug resistance and pan-drug resistance. Exposure to carbapenem antibiotics,central venous catheterization, mechanical ventilation, indwelling urinary catheter, WBC, and NEU are all independentrisk factors for CRAB infection in children.