新生儿院内超广谱β-内酰胺酶菌株所致肺炎临床相关因素分析

目的探讨新生儿病房超广谱β-内酰胺酶菌株所致院内肺炎的临床特点及相关因素。方法总结我 院新生儿科产超广谱β-内酰胺酶(ESBLs)细菌所致院内肺炎患儿的临床表现、病原学情况、影响因素及治疗转归。 结果在81例院内肺炎的新生儿呼吸道分泌物中培养出产ESBLs细菌34株,来源于31例新生儿院内肺炎的患 儿,主要以肺炎克雷伯菌、大肠埃希菌为主;同期同类菌属中非产ESBLs菌株所致的新生儿院内肺炎50例,致病菌 株50株。产ESBLs菌株对三代头孢菌素、氨曲南、氨苄西林耐药率高,对亚胺培南普遍敏感,对阿米卡星、头孢吡 肟部分敏感。使用三代头孢菌素治疗组与其它抗菌药物治疗组产ESBLs菌株分离率分别为65.12％,7.89％,两组 比较,差异有显著性(P<0.01);早产儿组产ESBLs细菌菌株分离率(63.64％)明显高于足月儿组(20.83％),两 组比较,差异有显著性(P<0.01);在本组研究的患儿疾病种类中,以新生儿感染性肺炎、新生儿肺透明膜病患儿 院内感染产ESBLs细菌的分离率较高,分别为70.00％,58.33％;非产ESBLs细菌感染组平均机械通气时间为5.6 ±1.7 d,明显低于产ESBLs细菌感染组(9.8±2.9 d),两组比较,差异有显著性(P<0.01)。结论广泛或长时 间使用第三头孢菌素、早产、长时间机械通气为产ESBLs细菌感染的危险因素;对于产ESBLs

Risk factors of hospital acquired pneumonia caused by extended-spectrum β-lactamase-producing strains in newborns

Objective To assess the clinical characteristic and risk factors of hospital acquired pneumonia in newborns caused by extended-spectrum 3-lactamase (ESBLs )-producing strains. Methods Clinical feature, pathogens, and therapeutic results of the 81 newborns with hospital acquired pneumonia were reviewed. Results Thirty-four ESBL-produing strains were isolated from the respiratory tract specimens of 31 cases, 50 of non-ESBL-producing strains were identified in the other 50 cases. There were high resistance to the third-generation cephalosporins, aztreonam, ampicillin for ESBL-producing strains, but these strains were all sensitive to imipenem, and partially sensitive to amikacin and cefepime. The isolation rate of ESBL-producing strains in patients treated by the third-generation cephalosporins and other antimicrobial agents was 65.12% and 7.89% respectively ( P <0.01). Isolation rate of ESBL-producing strains in premature newborns was 63.64%, which was significantly higher than that of full-term newborns (20.83% ) ( P < 0.01). Average mechanical ventilation time in the newborns with infection caused by non-ESBL-producing strains (5.6 d + 1.7 d) was significantly lower than that by ESBL-producing strains (9.8 d + 2.9 d) ( P < 0.01). Conclusion Extensive or long time use of the third-generation cephalosporins, premature newborns, and long time mechanical ventilation were the risk factors of the infection caused by ESBL-producing strains. Imipenem/cilastatin was the most effective antimicrobial agents for ESBL-producing strain infection.