新生儿耐碳青霉烯类肠杆菌感染影响因素

目的 探讨新生儿耐碳青霉烯类肠杆菌（CRE）感染的危险因素，为新生儿CRE感染防控和抗菌药物合理使用提供依据。方法 选择武汉儿童医院新生儿病区2016-2018年CRE感染新生儿68例（CRE组），随机选取同期同病房碳青霉烯类敏感肠杆菌（CSE）感染新生儿50例（CSE组），进行回顾性病例对照研究，分析CRE感染的危险因素。结果 CRE组新生儿68例，其中肺炎克雷伯菌感染60例（88.24%），大肠埃希菌感染7例（10.29%），产酸肺炎克雷伯菌感染1例（1.47%）。CRE组医院感染38例（55.88%），CSE组医院感染6例（12.00%），两组比较差异有统计学意义（P<0.05）。两组新生儿均以下呼吸道感染为主。单因素分析显示，小胎龄、低出生体重、新生儿呼吸窘迫综合征、气管插管、机械通气时间、PICC置管、抗菌药物使用时间、抗菌药物使用种类≥ 3种、碳青霉烯类药物使用史、糖皮质激素使用史、住院时间长均为新生儿感染CRE的危险因素。多因素回归分析显示，低出生体重、机械通气日数、碳青霉烯类药物使用史为CRE感染的独立危险因素。结论 新生儿CRE感染以医院感染为主，应针对新生儿CRE感染危险因素制定综合性防控措施，以减少CRE感染的发生和传播。

Influencing factors for carbapenem-resistant Enterobacteriaceae infection in neonates

Objective To explore risk factors for neonatal carbapenem-resistant Enterobacteriaceae (CRE) infection, and provide evidence for prevention and control of neonatal CRE infection and rational use of antimicrobial agents. Methods 68 neonates with CRE infection in a neonatal ward of Wuhan Children's Hospital from 2016 to 2018 were chosen as CRE group, 50 neonates with carbapenem-sensitive Enterobacteriaceae (CSE) infection in the same ward during the same period were randomly selected as CSE group, retrospective case-control study was conducted, risk factors for CRE infection were analyzed. Results There were 68 neonates in CRE group, including 60 cases (88.24%) of Klebsiella pneumoniae infection, 7 cases (10.29%) of Escherichia coli infection and 1 case (1.47%) of Klebsiella oxytoca infection. There were 38 cases (55.88%) of healthcare-associated infection(HAI) in CRE group and 6 cases (12.00%) of HAI in CSE group, difference between two groups of neonates was significant (P<0.05). Lower respiratory tract was the main infection site in both groups. Univariate analysis showed that small gestational age, low birth weight, neonatal respiratory distress syndrome, endotracheal intubation, mechanical ventilation time, peripherally inserted central catheterization (PICC), antimicrobial use time, types of used antimicrobial agents ≥ 3 kinds, use history of carbapenems, use history of glucocorticoid, long hospital stay were all risk factors for neonatal CRE infection. Multivariate regression analysis showed that low birth weight, duration of mechanical ventilation and history of carbapenem use were independent risk factors for CRE infection. Conclusion The main neonatal CRE infection is HAI, comprehensive prevention and control measures should be formulated according to the risk factors of neonatal CRE infection, so as to reduce the occurrence and spread of CRE infection.