摘要
目的 探讨儿童重症监护室(PICU)住院患儿多重耐药菌(MDROs)的感染特点、耐药性及危险因素.方法 以检出542株病原菌株的住院患儿为研究对象,收集患儿年龄等一般资料、病原菌资料、侵袭性操作情况及送检标本前抗生素使用情况等资料,根据患儿年龄、性别、主要疾病所属系统、标本类型等不同因素分别分组,采用率(％)分析MDROs的分布特点;根据MDROs检出年限分疫情前组和疫情时组,采用卡方检验分析MDROs的变化趋势;根据MDROs的耐药率分为耐药率高、耐药率低及未产生耐药率组,采用率(％)分析MDROs的耐药性;根据MDROs是否多重耐药分为MDROs和非MDROs组,采用卡方检验及二元logistics回归分析MDROs感染的危险因素.结果 检出MDROs的占比为21.2％(115/542),以耐碳青霉烯类鲍曼不动杆菌(CRABA)48株(41.8％)检出为主;与疫情前组比较,疫情时组产超广谱β-内酰胺酶类(ESBLs)检出下降(P＜0.001)、CRABA检出上升(P=0.003);耐甲氧西林金黄色葡萄球菌(MRSA)对青霉素类、头孢菌素类、大环内酯类耐药率高,对万古霉素、替考拉宁未产生耐药;大部分革兰阴性MDROs对氨苄西林、氨曲南、头孢类、碳青霉烯类耐药率高,其中耐碳青霉烯类MDROs对替加环素、头孢哌酮钠舒巴坦钠耐药率低或未产生耐药,ESBLs对碳青霉烯类未产生耐药;机械通气、侵入性操作、送检标本前抗生素使用≥3种、PICU住院时间≥7 d是MDROs感染的危险因素(P＜0.05).结论 PICU检出的MDROs对小部分抗生素耐药率低或未产生耐药,机械通气、侵入性操作、送检标本前抗生素使用≥3种、PICU住院时间≥7 d是MDROs感染的危险因素.
Abstract
Objective To explore the characteristics,drug resistance and risk factors of infection with multidrug-resistant organisms(MDROs)in children hospitalized in pediatric intensive care unit(PICU).Methods Hospitalized children with detected 542 strains of pathogenic bacteria were selected as research subjects.General data such as age,pathogen data,invasive procedures,and prior antibiotic use before specimen collection were collected.The distribution characteristics of MDROs were analyzed based on different factors such as age,gender,main disease system and specimen type using percentage(％)analysis.MDROs were divided into pre-pandemic and post-pandemic groups based on their detection years,and chi-square test was used to analyze the trend of MDROs change.According to the drug resistance rate of MDROs,MDROs were classified into high drug resistance rate,low drug resistance rate and no drug resistance rate groups,and analyzed using percentage(％)analysis.MDROs were divided into MDROs and non-MDROs groups based on whether they are multidrug-resistant or not.The risk factors for MDROs infection were analyzed using chi-square test and binary logistic regression analysis.Results The detection rate of MDROs was 21.2％(115/542),with carbapenem-resistant acinetobacter baumannii(CRABA)being the most detected strain(48 strains,41.8％).When compared with the pre-epidemic group,the detection of extended-spectrum β-lactamases(ESBLs)was decreased(P＜0.001),while CRABA detection was increased in the epidemic group(P=0.003).Methicillin-resistant Staphylococcus aureus(MRSA)exhibited high resistance rates to penicillins,cephalosporins and macrolides,but no resistance to vancomycin and linezolid.Most gram-negative MDROs showed high resistance rates to ampicillin,aztreonam,cephalosporins,and carbapenems,while carbapenem-resistant MDROs exhibited low or no resistance to tigecycline and Cefoperazone sodium-Sulbactam sodium.ESBLs showed no resistance to carbapenems.Mechanical ventilation,invasive procedures,prior use of≥3 antibiotics before specimen collection and PICU stay ≥ 7 days were identified as risk factors for MDROs infection(P＜0.05).Conclusion MDROs detected in the PICU exhibit low or no resistance to a small subset of antibiotics.Mechanical ventilation,invasive procedures,prior use of≥3 antibiotics before specimen collection and PICU stay ≥7 days are risk factors for MDROs infection.
基金项目
贵州省科技计划项目(黔科合基础-ZK[2023]一般347)
维普
万方数据