儿童产超广谱β-内酰胺酶菌株感染危险因素分析

目的：研究儿童产超广谱β-内酰胺酶（ESBLs）菌株感染的危险因素。方法：回顾性分析2009年2月至2011年1月242例下呼吸道感染住院患儿的临床资料,应用单因素分析和非条件logistic回归分析进行产ESBLs菌株感染的危险因素调查。结果：单因素分析显示6个因素与产ESBLs菌株感染有关：反复口鼻腔吸痰（OR=2.279,P<0.01）、气管插管（OR=3.101,P<0.01）、应用第三代头孢菌素大于3 d（OR=3.628,P<0.01）、入住儿科重症监护病房（PICU）（OR=2.378,P<0.01）、留置鼻饲管（OR=2.460,P<0.01）、预防应用抗生素（OR=1.747,P<0.05）。非条件logistic多元回归分析显示,应用第三代头孢菌素大于3 d（OR=5.672,P<0.01）、反复口鼻腔吸痰（OR=3.917,P<0.01）、气管插管（OR=3.717,P<0.01）、留置鼻饲管（OR=2.961,P<0.01）、入住PICU（OR=3.237,P<0.01）为产ESBLs感染菌的独立危险因素。结论：产ESBLs菌株感染为多因素所致,其中主要与第三代头孢菌素的使用、侵袭性操作、入住PICU密切相关。

Risk factors for infection with extended-spectrum beta-lactamase-producing strains in children

Objective To study the risk factors for infection with extended-spectrum beta-lactamase(ESBL)-producing strains in children.Methods The clinical data of 242 pediatric in-patients with lower respiratory tract infections from February 2009 to January 2011 were retrospectively analyzed.The risk factors of ESBL-producing strain infections were investigated using univariate analysis and multivariate logistic regression analysis.Results Univariate analysis showed that six factors were related with ESBL-producing strain infections: repeated sucking of phlegm(OR: 2.279,P<0.01),tracheal intubation(OR: 3.101,P<0.01),administration of the third generation cephalosporin for more than three days(OR: 3.628,P<0.01),admission to the pediatric intensive care unit(PICU)(OR: 2.378,P<0.01),indwelling of nasogastric tube(OR: 2.460,P<0.01),prophylactic use of antibiotics(OR: 1.747,P<0.05).Multivariate logistic regression showed that the application of the third-generation cephalosporin for more than three days(OR: 5.672,P<0.01),repeated sucking of phlegm(OR: 3.917,P<0.01),tracheal intubation(OR: 3.717,P<0.01),indwelling of nasogastric tube(OR: 2.961,P<0.01),and admission to PICU(OR: 3.237,P<0.01)were the independent risk factors for the infections.Conclusions The infections of ESBL-producing strains are caused by many factors,among which the application of the third-generation cephalosporin for more than three days,invasive operations,and admission to PICU are the independent risk factors.