[1]朱　萍,李德亮,张伟业.下呼吸道感染新生儿多重耐药菌感染及影响因素分析[J].新乡医学院学报,2020,37(7):670-673.[doi:10.7683/xxyxyxb.2020.07.017]
　ZHU Ping,LI Deliang,ZHANG Weiye.Analysis of multidrug-resistant bacteria infection and its influencing factors in neonates with lower respiratory infection[J].Journal of Xinxiang Medical University,2020,37(7):670-673.[doi:10.7683/xxyxyxb.2020.07.017]
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下呼吸道感染新生儿多重耐药菌感染及影响因素分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年7
页码:
670-673
栏目:
临床研究
出版日期:
2020-07-05

文章信息/Info

Title:
Analysis of multidrug-resistant bacteria infection and its influencing factors in neonates with lower respiratory infection
作者:
朱　萍; 李德亮; 张伟业
（南阳市中心医院新生儿重症监护科，河南　南阳　473000）
Author(s):
ZHU Ping; LI Deliang; ZHANG Weiye
(Neonatal intensive care unit,Nanyang Central Hospital,Nanyang 473000,Henan Province,China)
关键词:
新生儿; 下呼吸道感染; 病原菌; 多重耐药菌; 危险因素
Keywords:
neonate; lower respiratory infection; pathogenic bacteria; multidrug-resistant bacteria; risk factors
分类号:
R722.13
DOI:
10.7683/xxyxyxb.2020.07.017
文献标志码:
A
摘要:
目的　探讨下呼吸道感染新生儿多重耐药菌感染及影响因素。方法　选择2016年1月至2018年12月南阳市中心医院收治的489例下呼吸道感染新生儿为研究对象，采集患儿痰液标本进行病原菌检测，对获得的病原菌进行药物敏感性试验，并分析下呼吸道感染新生儿多重耐药菌感染的危险因素。结果　489份痰液标本共分离出病原菌564株，其中革兰阳性菌168株（29.79%），革兰阴性菌375株（66.49%），真菌21株（3.72%）。新生儿下呼吸道感染主要病原菌中，金黄色葡萄球菌对头孢唑啉、头孢他啶、哌拉西林的耐药率较高，表皮葡萄球菌对头孢曲松、头孢唑啉、阿奇霉素耐药率较高，肺炎链球菌对阿米卡星、氨苄西林的耐药率较高，大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对头孢曲松、头孢唑啉、头孢他啶的耐药率较高，鲍曼不动杆菌对氨苄西林、左氧氟沙星、庆大霉素的耐药率较高，阴沟肠杆菌对头孢曲松、头孢唑啉、阿米卡星、氨苄西林的耐药率较高。489例下呼吸道感染新生儿中，多重耐药菌感染患儿46例，共分离出多重耐药菌株52株，包括肺炎克雷伯菌14株（26.92%），大肠埃希菌12株（23.08%），金黄色葡萄球菌9株（17.30%），鲍曼不动杆菌6株（11.53%），表皮葡萄球菌5株（9.62%），铜绿假单胞菌4株（7.70%），阴沟肠杆菌2株（3.85%）。单因素分析结果显示，新生儿日龄、住院时间、抗生素应用、胃管留置时间、机械通气时间与新生儿下呼吸道多重耐药菌感染有关（P<0.05），新生儿性别、体质量指数、合并症与下呼吸道多重耐药菌感染无关（P>0.05）。Logistic回归分析结果显示，住院时间、应用多种抗生素、胃管留置时间≥5 d、机械通气时间≥5 d是下呼吸道感染新生儿多重耐药菌感染的危险因素（P<0.05）。结论　新生儿下呼吸道感染病原菌主要有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌、金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌，多重耐药菌主要有肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、鲍曼不动杆菌、表皮葡萄球菌、铜绿假单胞菌、阴沟肠杆菌。住院时间长、抗生素应用种类较多、胃管留置时间长、机械通气时间长是下呼吸道感染新生儿多重耐药菌感染的危险因素。
Abstract:
Objective　To investigate the multidrug-resistant bacteria infection and its influencing factors in neonates with lower respiratory infection.Methods　A total of 489 neonates with lower respiratory infection admitted to Nanyang Central Hospital from January 2016 to December 2018 were selected as the research subjects.The sputum samples of children were collected for pathogenic bacteria detection,and the drug sensitivity test was carried out for the acquired pathogenic bacteria,and the risk factors of multidrug-resistant bacteria infection in neonates with lower respiratory infection were analyzed.Results　A total of 564 strains of pathogenic bacteria were isolated from 489 sputum samples,including 168 (29.79%) strains of Gram-positive bacteria,375 (66.49%) strains of Gram-negative bacteria and 21 (3.72%) strains of fungi.Among the main pathogenic bacteria in neonates with lower respiratory infection,the Staphylococcus aureus had the higher resistance rate to cephazolin,ceftazidime and piperacillin;the Staphylococcus epidermidis had the higher resistance rate to ceftriaxone,cefazolin and azithromycin;the Streptococcus pneumoniae had the higher resistance rate to amikacin and ampicillin;the Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa had the higher resistance rate to ceftriaxone,cefazolin and ceftazidime;the Acinetobacter baumannii had the higher resistance to ampicillin,levofloxacin and gentamycin;the Enterobacter cloacae had the higher resistance to ceftriaxone,cefazolin,amikacin and ampicillin.Among the 489 neonates with lower respiratory infection,there were 46 neonates with multidrug-resistant bacteria infection,and 52 strains of multidrug-resistant bacteria were isolated,including 14 (26.92%) strains of Klebsiella pneumoniae,12 (23.08%) strains of Escherichia coli,9 (17.30%) strains of Staphylococcus aureus,6 (11.53%) strains of Acinetobacter baumannii,5 (9.62%) strains of Staphylococcus epidermidis,4 (7.70%) strains of Pseudomonas aeruginosa and 2 (3.85%) strains of Enterobacter cloacae.The results of univariate analysis showed that the age of newborn,hospitalization time,antibiotic application,gastric tube retention time and mechanical ventilation time were related to lower respiratory multidrug-resistant bacteria infection in neonates (P<0.05);but the sex,body mass index and complications of neonates were not related to lower respiratory multidrug-resistant bacteria infection (P>0.05).The results of logistic regression analysis showed that the hospitalization time,the application of multiple antibiotics,gastric tube retention time ≥ 5 days,and the mechanical ventilation time ≥ 5 days were the risk factors of multidrug-resistant bacteria infection in neonates with lower respiratory infection (P<0.05).Conclusion　The main pathogenic bacteria of lower respiratory infection in neonates are Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Enterobacter cloacae,Staphylococcus aureus,Staphylococcus epidermidis and Streptococcus pneumoniae.The main multidrug-resistant bacteria are Klebsiella pneumoniae,Escherichia coli,Staphylococcus aureus,Acinetobacter baumannii,Staphylococcus epidermidis,Pseudomonas aeruginosa and Enterobacter cloacae.The longer hospitalization time,multiple antibiotic applications,longer gastric tube retention time and longer mechanical ventilation time were the risk factors of multidrug-resistant bacteria infection in neonates with lower respiratory infection.

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更新日期/Last Update: 2020-07-05