摘要
目的探讨新生儿院内感染的病原菌分布特点及相关危险因素。方法选取155例本院新生儿科接诊的院内感染患儿及150例未发生院内感染的新生儿为研究对象。通过本院电子病历系统收集患儿临床资料,回顾性分析新生儿院内感染的危险因素。采集患儿多种标本,进行病原菌鉴定与药敏试验。结果155例新生儿院内感染患儿,共采集标本168份,42.86%为痰液标本(72/168),其次为血液标本、咽拭子标本、脑脊液标本、尿液标本等。共检出病原菌168株。其中革兰阴性菌88株,主要为肺炎克雷伯菌(16.67%,28/168)与大肠埃希菌(12.50%,21/168)。革兰阳性菌70株,主要为金黄色葡萄球菌(15.48%,26/168)与肺炎链球菌(11.31%,19/168)。真菌10株(5.95%,10/168),主要为白色假丝酵母菌(4.17%,7/168)。155例院内感染患儿中,极低出生体重患儿31例,低出生体重患儿89例,正常出生体重患儿24例,巨大儿患儿11例。极低出生体重组患儿共检出病原菌39株,其中革兰阴性菌23株,革兰阳性菌9株,真菌7株。低出生体重组患儿共检出病原菌94株,其中革兰阴性菌53株,革兰阳性菌40株,真菌1株。正常出生体重组患儿共检出病原菌24株,其中革兰阴性菌7株,革兰阳性菌16株,真菌1株。巨大儿组患儿共检出病原菌11株,其中革兰阴性菌5株,革兰阳性菌5株,真菌1株。不同出生体重分组患儿,革兰阴性菌、真菌构成比差异有统计学意义(P<0.05),革兰阳性菌构成比差异无统计学意义(P>0.05)。肺炎克雷伯菌对氨苄西林/舒巴坦、头孢呋辛、庆大霉素的耐药率高于50%,对亚胺培南、美罗培南的耐药率低于10%。大肠埃希菌对头孢呋辛的耐药率高于50%,对头孢他啶、美罗培南、亚胺培南、阿米卡星、阿莫西林/克拉维酸的耐药率低于10%。金黄色葡萄球菌对青霉素G、阿莫西林、红霉素、罗红霉素、阿奇霉素的耐药率高于50%,未产生对万古霉素、替考拉宁的耐药株。肺炎链球菌对青霉素G、红霉素、罗红霉素、阿奇霉素、四环素的耐药率高于50%,对万古霉素、替考拉宁、庆大霉素的耐药率低于10%。感染组与对照组新生儿在胎龄、出生体重、产妇孕期并发症、Apgar评分、羊水污染、新生儿窒息、使用呼吸机、气管插管、留置胃管、中心静脉置管、住院时间差异有统计学意义(P<0.05),在性别、分娩方式、是否多胎差异无统计学意义(P>0.05)。进一步进行二元Logistic回归分析,胎龄<37周、出生体重<2.5 kg、使用呼吸机、气管插管、留置胃管、住院时间≥7 d、中心静脉置管、Apgar评分<5分是新生儿院内感染的独立危险因素(P<0.05)。结论新生儿科院内感染患儿病原菌以肺炎克雷伯菌、金黄色葡萄球菌为主,不同出生体重患儿的病原菌构成情况不同。肺炎克雷伯菌、大肠埃希菌对第二代头孢菌素的耐药率较高,肺炎链球菌、金黄色葡萄球菌对青霉素、大环内酯类的耐药率较高。胎龄<37周、出生体重<2.5 kg、使用呼吸机、气管插管、留置胃管、住院时间≥7 d、中心静脉置管、Apgar评分<5分是新生儿发生院内感染的独立危险因素。
Objective To explore the distribution characteristics and related risk factors of pathogens in neonatal hospital infections.Methods 155 pediatric patients with hospital acquired infections and 150 newborns with not hospital acquired infections were selected as the study subjects.The clinical data of infants were collected by our hospital's electronic medical record system to analyze the relevant risk factors for neonatal complications of hospital acquired infections by a retrospective survey method.The various specimens were collected from the affected children for pathogen identification and drug sensitivity testing.Results A total of 168 specimens were collected from 155 newborns with hospital acquired infections,of which 42.86%were sputum specimens(72/168),followed by blood specimens,pharyngeal swab specimens,cerebrospinal fluid specimens,urine specimens,etc.A total of 168 strains of pathogenic bacteria were detected.Among them,there were 88 strains of Gram negative bacteria,mainly Klebsiella pneumoniae(16.67%,28/168)and Escherichia coli(12.50%,21/168).70 strains of Gram positive bacteria,mainly Staphylococcus aureus(15.48%,26/168)and S.pneumoniae(11.31%,19/168).10 fungi(5.95%,10/168),mainly Candida albicans(4.17%,7/168).Among 155 cases of hospital acquired infections,there were 31 cases of extremely low birth weight,89 cases of low birth weight,24 cases of normal birth weight,and 11 cases of macrosomia.A total of 39 strains of pathogenic bacteria were detected in children with extremely low birth weight,including 23 strains of Gram negative bacteria,9 strains of Gram positive bacteria,and 7 strains of fungi.A total of 94 strains of pathogenic bacteria were detected in children with low birth weight,including 53 strains of Gram negative bacteria,40 strains of Gram positive bacteria,and 1 strain of fungi.A total of 24 strains of pathogenic bacteria were detected in the normal birth weight group of children,including 7 strains of Gram negative bacteria,16 strains of Gram positive bacteria,and 1 strain of fungi.A total of 11 strains of pathogenic bacteria were detected in children with macrosomia,including 5 strains of Gram negative bacteria,5 strains of Gram positive bacteria,and 1 strain of fungi.The difference in the composition of Gram negative bacteria and fungi among children of different birth weight groups was statistically significant(P<0.05),while the difference in the composition of Gram positive bacteria was not statistically significant(P>0.05).The resistance rate of K.pneumoniae to ampicillin/sulbactam,cefuroxime,and gentamicin was over 50%,while the resistance rate to imipenem and meropenem was less than 10%.The resistance rate of E.coli to cefuroxime was over 50%,while the resistance rate to ceftazidime,meropenem,imipenem,amikacin,amoxicillin/clavulanic acid was less than 10%.The resistance rate of S.aureus to penicillin G,amoxicillin,erythromycin,roxithromycin,and azithromycin was over 50%,and no resistant strains to vancomycin or teicoplanin had been developed.The resistance rate of S.pneumoniae to penicillin G,erythromycin,roxithromycin,azithromycin,and tetracycline was over 50%,while the resistance rate to vancomycin,teicoplanin,and gentamicin was less than 10%.There was a statistically significant difference(P<0.05)between the infection group and the control group in terms of gestational age,birth weight,maternal complications,Apgar score,amniotic fluid contamination,neonatal asphyxia,use of respirators,tracheal intubation,indwelling gastric tubes,central venous catheterization,and hospitalization time.However,there was no statistically significant difference(P>0.05)in terms of gender,delivery method,and whether there were multiple births.Further binary logistic regression analysis showed that gestational age<37 weeks,birth weight<2.5 kg,use of ventilator,tracheal intubation,indwelling gastric tube,hospital stay≥7 days,central venous catheterization,and Apgar score<5 were independent risk factors for neonatal hospital acquired infections(P<0.05).Conclusion The main pathogens causing nosocomial infections in newborns were K.pneumoniae and Staphylococcus aureus,and the composition of pathogens varied among children with different birth weights.K.pneumoniae and E.coli had higher resistance rates to second-generation cephalosporins,while S.pneumoniae and S.aureus had higher resistance rates to penicillin and macrolides.Gestational age<37 weeks,birth weight<2.5 kg,use of ventilator,tracheal intubation,indwelling gastric tube,hospital stay≥7 days,central venous catheterization,and Apgar score<5 were independent risk factors for neonatal hospital acquired infections.
作者
黄生才
黄超
何江
胡海
HUANG Shengcai;HUANG Chao;HE Jiang;HU Hai(Departmentof Neonatologyof Fuzhou Maternal and Child Health Hospital,Fuzhou 3440o0,Jiangri,China;Department of Pediatrics of Fuzhou Maternal and Child Health Hospital)
出处
《中国病原生物学杂志》
CSCD
北大核心
2024年第6期715-719,共5页
Journal of Pathogen Biology
关键词
新生儿
院内感染
病原菌
危险因素
newborns
intrahospital infection
pathogenic bacteria
risk factors
