新生儿重症监护病房多重耐药菌感染的特征和危险因素分析

目的 分析新生儿重症监护病房（NICU）多重耐药菌（MDRO）感染的分布特征,并探讨NICU发生MDRO感染的危险因素,为减少MDRO感染提供临床依据。方法 回顾性分析MDRO感染的患儿病历资料。根据《MDR、XDR、PDR多重耐药菌暂行标准定义——国际专家建议》,从NICU选出MDRO感染的151例患儿220株细菌,并以同期该病区非MDRO感染的272例患儿为对照。分析MDRO的分布情况,运用单因素及多因素logistic回归分析MDRO感染相关的影响因素。结果 不同年份中,NICU检出的最为常见MDRO为大肠埃希菌、其次为葡萄球菌属。产前母亲使用抗生素、PICC置管、腰椎穿刺、低蛋白血症及淋巴细胞比值是NICU发生MDRO感染的影响因素（P均< 0.05）。其中母亲产前1周内使用抗生素者相对于母亲产前1周内没有使用抗生素者感染MDRO的风险增加（OR = 2.268,95%CI 1.095 ~ 4.700）,有低蛋白血症者相对于无低蛋白血症者感染MDRO的风险增加（OR = 4.999,95%CI 2.849 ~ 8.700）,行腰椎穿刺者相对于没有行腰椎穿刺者感染MDRO的风险降低（OR = 0.368,95%CI 0.184 ~ 0.737）,行PICC置管者相对于没有行PICC置管者感染MDRO的风险降低（OR = 0.473,95%CI 0.266 ~ 0.842）,淋巴细胞比例每增加一个单位,感染MDRO的风险降低1.7% （OR = 0.983,95%CI 0.969 ~ 0.997）。结论 在NICU中,最为常见的MDRO为大肠埃希菌。母亲产前1周内使用抗生素、患儿有低蛋白血症是NICU患儿感染MDRO的危险因素。

Characteristics and risk factors of multidrug-resistant organisms infection in neonatal intensive care unit

Objective To analyze the characteristics of multidrug-resistant organisms （MDROs） in neonatal intensive care unit （NICU）, and to determine the risk factors of MDROs infection, aiming to provide clinical basis for reducing the risk of MDROs infection. Methods Medical record of children infected with MDROs were retrospectively analyzed. According to the "Multidrug-resistant （MDR）, extensively drug-resistant （XDR） and pandrug-resistant （PDR） bacteria： an international expert proposal for interim standard definitions for acquired resistance", 220 strains were isolated from 151 children with MDROs infection in NICU, and 272 counterparts without MDROs infection in NICU were enrolled as controls. The distribution characteristics of MDROs were analyzed. The risk factors related to the infection of MDROs were identified by univariate and multivariate Logistic regression analyses. Results Escherichia coli was the most common and widespread MDROs in different years, followed by Staphylococcus. Maternal intake of antibiotics within 1 week before delivery, peripherally inserted central venous catheters （PICC）, lumbar puncture, children with hypoproteinemia and lymphocyte ratio were significantly correlated with the infection of MDROs in NICU （all P < 0.05）. The risk of MDROs infection in mothers who took antibiotics within 1 week before delivery was significantly higher compared with that in those without use of antibiotics within 1 week before delivery （OR = 2.268, 95%CI 1.095-4.700）. Compared with patients without hypoproteinemia, the risk of MDROs infection in patients with hypoproteinemia was remarkably elevated （OR = 4.999, 95%CI 2.849-8.700）. The risk of MDROs infection in patients receiving lumbar puncture was significantly lower than that in their counterparts without lumbar puncture （OR = 0.368, 95%CI 0.184-0.737）. Compared with patients without PICC, the risk of MDROs infection in patients undergoing PICC was considerably decreased （OR = 0.473, 95%CI 0.266-0.842）. The risk of MDROs infection was reduced by 1.7% when the lymphocyte ratio was increased by 1% （OR = 0.983, 95%CI 0.969-0.997）. Conclusion Escherichia coli is the most common MDRO in NICU. Maternal intake of antibiotics within 1 week before delivery and children with hypoproteinemia are the risk factors for the infection of MDROs in NICU.