新生儿脓毒症中革兰阴性菌的分布特征及其多重耐药性与危险因素分析

Distribution characteristics,multidrug resistance,and risk factor analysis of Gram-negative bacteria in neonatal sepsis

目的系统分析新生儿脓毒症中革兰阴性菌的分布特征、耐药性模式及其相关的独立危险因素。方法选取2020年1月至2023年12月期间本院新生儿重症监护病房(NICU)的脓毒症患儿80例。每例新生儿均在脓毒症发病时采集血样,使用标准血培养方法进行病原菌鉴定,并依据临床实验室标准研究所(CLSI)的最新指导,采用纸片扩散法和微量肉汤稀释法评估抗生素敏感性。此外,收集新生儿的出生体重、早产史、母亲孕产史及抗生素使用情况等临床数据,并通过单变量和多变量Logistic回归分析,评估影响革兰阴性菌多重耐药性(MDR)及新生儿脓毒症患儿院内死亡的独立危险因素。结果在80例新生儿脓毒症患者中,共分离出120株革兰阴性菌,其中克雷伯菌属和大肠埃希菌为主要病原菌,分别占40.00%(48/120)和30.00%(36/120)。抗生素耐药性分析显示,革兰阴性菌对头孢曲松和氟氯西林的耐药率较高,分别为60.00%(72/120)和54.17%(65/120),其中MDR菌株占52.50%(63/120)。多因素Logistic回归分析显示,低出生体重(OR=2.52,95%CI=1.24-5.34,P<0.05)、早产(OR=2.34,95%CI=1.11-4.75,P<0.05)、妊娠期使用抗生素(OR=2.40,95%CI=1.31-4.71,P<0.05)、Apgar评分较低(OR=1.88,95%CI=1.12-3.14,P<0.05)和机械通气(OR=2.11,95%CI=1.04-4.51,P<0.05)是影响新生儿脓毒症中革兰阴性菌MDR的独立危险因素。此外,MDR菌株感染(OR=3.86,95%CI=2.02-7.38,P<0.05)、低出生体重(OR=3.26,95%CI=1.65-6.45,P<0.05)、早产(OR=2.77,95%CI=1.42-5.41,P<0.05)和机械通气(OR=2.34,95%CI=1.13-4.84,P<0.05)是新生儿脓毒症患儿院内死亡的独立危险因素。结论克雷伯菌属和大肠埃希菌是新生儿脓毒症中主要的革兰阴性菌,MDR菌株在新生儿中具有较高的发生率,并显著增加了院内死亡风险。低出生体重、早产、妊娠期使用抗生素、Apgar评分较低及机械通气需求是MDR的独立危险因素,这些因素也与新生儿脓毒症患儿的院内死亡显著相关。

Objective To systematically analyze the distribution characteristics,resistance patterns,and independent risk factors associated with Gram-negative bacteria in neonatal sepsis.Methods A total of 80 cases of neonatal sepsis were selected from the Neonatal Intensive Care Unit(NICU)of our hospital between January 2020 and December 2023.Blood samples were collected at the onset of sepsis from each neonate,and standard blood culture methods were used to identify pathogens.Antibiotic susceptibility was evaluated using the disc diffusion method and microbroth dilution method,following the latest guidelines from the Clinical and Laboratory Standards Institute(CLSI).Clinical data,including birth weight,history of preterm birth,maternal obstetric history,and antibiotic usage,were collected.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for multidrug-resistant(MDR)Gram-negative bacteria and in-hospital mortality in neonates with sepsis.Results A total of 120 strains of Gram-negative bacteria were isolated from the 80 cases,with Klebsiella species and Escherichia coli being the predominant pathogens,accounting for 40.00%(48/120)and 30.00%(36/120)of the isolates,respectively.Antibiotic resistance analysis revealed high resistance rates to ceftriaxone and flucloxacillin,at 60.00%(72/120)and 54.20%(65/120),respectively,with 52.50%(63/120)of the isolates being MDR strains.Multivariate logistic regression analysis identified low birth weight(OR=2.52,95%CI=1.24-5.34,P<0.05),preterm birth(OR=2.34,95%CI=1.11-4.75,P<0.05),maternal antibiotic use during pregnancy(OR=2.40,95%CI=1.31-4.71,P<0.05),lower Apgar scores(OR=1.88,95%CI=1.12-3.14,P<0.05),and the need for mechanical ventilation(OR=2.11,95%CI=1.04-4.51,P<O.05)as independent risk factors for MDR Gram-negative bacteria in neonatal sepsis.Furthermore,MDR bacterial infection(OR=3.86,95%CI=2.02-7.38,P<0.05),low birth weight(OR=3.26,95%CI=1.65-6.45,P<0.05),preterm birth(OR=2.77,95%CI=1.42-5.41,P<0.05),and mechanical ventilation(OR=2.34,95%CI=1.13-4.84,P<o.05)were identified as independent risk factors for in-hospital mortality among neonates with sepsis.Conclusion Klebsiella species and Escherichia coli are the primary Gram-negative pathogens in neonatal sepsis,with a high incidence of MDR strains,significantly increasing the risk of in-hospital mortality.Low birth weight,preterm birth,maternal antibiotic use during pregnancy,lower Apgar scores,and the need for mechanical ventilation are independent risk factors for MDR,and these factors are also significantly associated with in-hospital mortality in neonatal sepsis.