中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2013年
4期
217-220
,共4页
婴儿,新生%大肠埃希菌%超广谱β-内酰胺酶%微生物敏感性试验
嬰兒,新生%大腸埃希菌%超廣譜β-內酰胺酶%微生物敏感性試驗
영인,신생%대장애희균%초엄보β-내선알매%미생물민감성시험
Infant,newborn%Escherichia coli%Extended-spectrum beta-lactamases%Microbial sensitivity tests
目的 探讨住院新生儿感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的临床特点、菌株耐药性、感染的危险因素和疾病转归.方法 选取2010年1月至2013年1月宁波市妇女儿童医院新生儿病房产ESBLs大肠埃希菌感染患儿68例(产酶组),选取同期上报的多重耐药菌感染病例中不产ESBLs大肠埃希菌感染新生儿共81例为对照(不产酶组).对分离的产ESBLs大肠埃希菌采用K-B法进行药敏试验.结合患儿出生体质量、胎龄、分娩方式、感染部位和疾病转归等相关临床资料进行分析,采用Logistic回归方法分析新生儿感染产ESBLs大肠埃希菌的危险因素.结果 从68例新生儿采集的样本中,痰液样本产ESBLs大肠埃希菌的分离率最高(49/68,72.1％),其次为血液(7/68,10.3％)和尿液(6/68,8.8％).产ESBLs大肠埃希菌对氨苄西林、头孢噻肟、头孢吡肟和头孢他啶的耐药率均较高(61.8％～100.0％),但对头孢西丁、头孢哌酮/舒巴坦及阿米卡星的耐药率较低(2.9％～10.3％),对碳青霉烯类药物的耐药率均为0.产酶组和不产酶组新生儿均以下呼吸道感染为主.产酶组中,晚期新生儿以下呼吸道感染为主,与早期新生儿比较差异有统计学意义(x2=12.879,P＜0.05).多因素Logistic回归分析发现,胎龄＜37周(Exp (B) =0.352,95％ CI:0.134 ～0.929)、剖宫产(Exp (B)=0.488,95％ CI:0.243 ～0.984)、有侵入性操作(Exp(B)=0.363,95％CI:0.142 ～0.927)、母亲产前一周使用激素和/或抗菌药物(Exp (B) =0.325,95％CI:0.127 ～0.833)是新生儿感染产ESBLs大肠埃希菌的独立危险因素.结论 住院新生儿产ESBLs大肠埃希菌感染以呼吸道为主,感染菌株耐药性强,减少侵入性操作、严格掌握剖宫产以及产前使用激素和抗菌药物指征可减少产ESBLs大肠埃希菌感染的发生.
目的 探討住院新生兒感染產超廣譜β-內酰胺酶(ESBLs)大腸埃希菌的臨床特點、菌株耐藥性、感染的危險因素和疾病轉歸.方法 選取2010年1月至2013年1月寧波市婦女兒童醫院新生兒病房產ESBLs大腸埃希菌感染患兒68例(產酶組),選取同期上報的多重耐藥菌感染病例中不產ESBLs大腸埃希菌感染新生兒共81例為對照(不產酶組).對分離的產ESBLs大腸埃希菌採用K-B法進行藥敏試驗.結閤患兒齣生體質量、胎齡、分娩方式、感染部位和疾病轉歸等相關臨床資料進行分析,採用Logistic迴歸方法分析新生兒感染產ESBLs大腸埃希菌的危險因素.結果 從68例新生兒採集的樣本中,痰液樣本產ESBLs大腸埃希菌的分離率最高(49/68,72.1％),其次為血液(7/68,10.3％)和尿液(6/68,8.8％).產ESBLs大腸埃希菌對氨芐西林、頭孢噻肟、頭孢吡肟和頭孢他啶的耐藥率均較高(61.8％～100.0％),但對頭孢西丁、頭孢哌酮/舒巴坦及阿米卡星的耐藥率較低(2.9％～10.3％),對碳青黴烯類藥物的耐藥率均為0.產酶組和不產酶組新生兒均以下呼吸道感染為主.產酶組中,晚期新生兒以下呼吸道感染為主,與早期新生兒比較差異有統計學意義(x2=12.879,P＜0.05).多因素Logistic迴歸分析髮現,胎齡＜37週(Exp (B) =0.352,95％ CI:0.134 ～0.929)、剖宮產(Exp (B)=0.488,95％ CI:0.243 ～0.984)、有侵入性操作(Exp(B)=0.363,95％CI:0.142 ～0.927)、母親產前一週使用激素和/或抗菌藥物(Exp (B) =0.325,95％CI:0.127 ～0.833)是新生兒感染產ESBLs大腸埃希菌的獨立危險因素.結論 住院新生兒產ESBLs大腸埃希菌感染以呼吸道為主,感染菌株耐藥性彊,減少侵入性操作、嚴格掌握剖宮產以及產前使用激素和抗菌藥物指徵可減少產ESBLs大腸埃希菌感染的髮生.
목적 탐토주원신생인감염산초엄보β-내선알매(ESBLs)대장애희균적림상특점、균주내약성、감염적위험인소화질병전귀.방법 선취2010년1월지2013년1월저파시부녀인동의원신생인병방산ESBLs대장애희균감염환인68례(산매조),선취동기상보적다중내약균감염병례중불산ESBLs대장애희균감염신생인공81례위대조(불산매조).대분리적산ESBLs대장애희균채용K-B법진행약민시험.결합환인출생체질량、태령、분면방식、감염부위화질병전귀등상관림상자료진행분석,채용Logistic회귀방법분석신생인감염산ESBLs대장애희균적위험인소.결과 종68례신생인채집적양본중,담액양본산ESBLs대장애희균적분리솔최고(49/68,72.1％),기차위혈액(7/68,10.3％)화뇨액(6/68,8.8％).산ESBLs대장애희균대안변서림、두포새우、두포필우화두포타정적내약솔균교고(61.8％～100.0％),단대두포서정、두포고동/서파탄급아미잡성적내약솔교저(2.9％～10.3％),대탄청매희류약물적내약솔균위0.산매조화불산매조신생인균이하호흡도감염위주.산매조중,만기신생인이하호흡도감염위주,여조기신생인비교차이유통계학의의(x2=12.879,P＜0.05).다인소Logistic회귀분석발현,태령＜37주(Exp (B) =0.352,95％ CI:0.134 ～0.929)、부궁산(Exp (B)=0.488,95％ CI:0.243 ～0.984)、유침입성조작(Exp(B)=0.363,95％CI:0.142 ～0.927)、모친산전일주사용격소화/혹항균약물(Exp (B) =0.325,95％CI:0.127 ～0.833)시신생인감염산ESBLs대장애희균적독립위험인소.결론 주원신생인산ESBLs대장애희균감염이호흡도위주,감염균주내약성강,감소침입성조작、엄격장악부궁산이급산전사용격소화항균약물지정가감소산ESBLs대장애희균감염적발생.
Objective To investigate clinical features,drug resistance,risk factors and prognosis of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli infection in hospitalized newborns.Methods Sixty eight newborns infected with ESBLs-producing Escherichia coli admitted in Neonatal Ward of Ningbo Women and Children's Hospital during.January 2010 and January 2013 were enrolled in the study; 81 newborns infected with multiple resistant non-ESBLs-producing Escherichia coli served as controls.The drug sensitivity of the isolated ESBLs-producing Escherichia coli was tested using K-B method.Clinical data including birth weight,gestational age,mode of delivery,site of infection and disease outcome were analyzed.Logistic regression analysis was performed to study the risk factors for ESBLs-producing Escherichia coli infection.Results The highest positive rate of ESBLs-producing Escherichia coli was detected in sputum samples (49/68,72.1％),followed by blood (7/68,10.3％) and urine (6/68,8.8％) samples.Strains were highly resistant to ampicillin,cefotaxime,ceftazidime and cefepime (61.8％-100.0％),but the resistant rates to cefoxitin,cefoperazone/sulbactam and amikacin were low (2.9％-10.3％),and were completely sensitive to carbapenems.Lower respiratory tract infections were most popular in both groups,but in ESBLs-producing Escherichia coli infected group,lower respiratory tract infection rate in late newborns was higher than that in early newborns (x2 =12.879,P ＜ 0.05).Multivariate logistic regression analysis showed that gestational age ＜ 37 weeks (Exp (B) =0.352,95％ CI:0.134-0.929),cesarean section (Exp (B) =0.488,95 ％ CI:0.243-0.984),invasive procedures (Exp (B) =0.363,95 ％ CI:0.142-0.927),use of hormones and/or antibiotics one week before birth (Exp (B)=0.325,95％ CI:0.127-0.833) were independent risk factors for ESBLs-producing Escherichia coli infection.Conclusions Respiratory tract infection is popular in ESBLs-producing Escherichia coli infection in hospitalized newborns.The strains are highly resistant to most antibiotics.Reducing invasive procedures,strict control of cesarean section and prenatal use of hormones and antibiotics may reduce the infection of ESBLs-producing Escherichia coli in newborns.
