CAJ | 학술논문

目的：探讨新生儿科病房碳青霉烯类耐药肺炎克雷伯菌（ CRKP ）的耐药性及新生儿发生CRKP定植的危险因素。方法连续收集2012年1月至2014年6月在天津医科大学第二医院新生儿科病房住院、咽拭子培养结果为肺炎克雷伯菌的病例资料，共108例。采用病例对照研究方法分两组，病例组为定植CRKP的新生儿23例，对照组为定植碳青霉烯类敏感肺炎克雷伯菌（ CSKP ）的新生儿85例。采用χ2检验和Fisher确切概率法比较两组肺炎克雷伯菌对21种抗菌药物的耐药性，对两组病例进行单因素及Logistic多因素回归分析，了解新生儿发生CRKP定植的危险因素。结果CRKP对多种青霉素类和头孢菌素类抗菌药物及复方磺胺甲噁唑的耐药率高达100％，对碳青霉烯类的美罗培南和亚胺培南的耐药率分别为95.7％和87.0％。除对阿米卡星、庆大霉素、环丙沙星、四环素的敏感率为100％外，CRKP对其他16种抗菌药物的耐药率均明显高于CSKP（P值均＜0.05）。单因素分析结果显示，使用头孢西丁（χ2＝20.053，P＜0.01）、吸痰（χ2＝15.817，P＜0.01）、胃肠减压（χ2＝10.731，P＜0.01）、鼻饲（χ2＝15.146，P＜0.01）、侵入性操作种类（χ2＝22.572，P＜0.01）、胎儿出生体质量（χ2＝6.026，P＜0.05）、检出CRKP／CSKP的累计培养次数（χ2＝18.577，P＜0.01）、母亲妊娠高血压综合征（χ2＝8.698，P＜0.01）、早产（χ2＝4.904，P＜0.05）、产前住院经历（χ2＝8.396，P＜0.01）、小于胎龄儿（χ2＝7.295，P＜0.05）、胎龄（χ2＝7.294，P＜0.05）、胎膜早破（χ2＝9.397，P＜0.01）、住院天数（χ2＝14.649，P＜0.01）和新生儿重症监护病房（NICU）收治（χ2＝11.050，P＜0.01）是新生儿发生CRKP定植的危险因素。多因素回归分析结果显示，母亲妊娠高血压综合征（ OR＝9.718，P＜0.01）、胎膜早破（＜24 h）（OR＝6.640，P＜0.01）和NICU收治（OR＝4.119，P＜0.05）是新生儿发生CRKP定植的独立危险因素。结论新生儿定植CRKP的耐药形势严峻。采取措施预防或者缓解母亲妊娠高血压综合征、胎膜早破病情的发展，加强NICU细菌耐药监测可减少新生儿发生CRKP定植，防止耐药菌播散。目的：探討新生兒科病房碳青黴烯類耐藥肺炎剋雷伯菌（ CRKP ）的耐藥性及新生兒髮生CRKP定植的危險因素。方法連續收集2012年1月至2014年6月在天津醫科大學第二醫院新生兒科病房住院、嚥拭子培養結果為肺炎剋雷伯菌的病例資料，共108例。採用病例對照研究方法分兩組，病例組為定植CRKP的新生兒23例，對照組為定植碳青黴烯類敏感肺炎剋雷伯菌（ CSKP ）的新生兒85例。採用χ2檢驗和Fisher確切概率法比較兩組肺炎剋雷伯菌對21種抗菌藥物的耐藥性，對兩組病例進行單因素及Logistic多因素迴歸分析，瞭解新生兒髮生CRKP定植的危險因素。結果CRKP對多種青黴素類和頭孢菌素類抗菌藥物及複方磺胺甲噁唑的耐藥率高達100％，對碳青黴烯類的美囉培南和亞胺培南的耐藥率分彆為95.7％和87.0％。除對阿米卡星、慶大黴素、環丙沙星、四環素的敏感率為100％外，CRKP對其他16種抗菌藥物的耐藥率均明顯高于CSKP（P值均＜0.05）。單因素分析結果顯示，使用頭孢西丁（χ2＝20.053，P＜0.01）、吸痰（χ2＝15.817，P＜0.01）、胃腸減壓（χ2＝10.731，P＜0.01）、鼻飼（χ2＝15.146，P＜0.01）、侵入性操作種類（χ2＝22.572，P＜0.01）、胎兒齣生體質量（χ2＝6.026，P＜0.05）、檢齣CRKP／CSKP的纍計培養次數（χ2＝18.577，P＜0.01）、母親妊娠高血壓綜閤徵（χ2＝8.698，P＜0.01）、早產（χ2＝4.904，P＜0.05）、產前住院經歷（χ2＝8.396，P＜0.01）、小于胎齡兒（χ2＝7.295，P＜0.05）、胎齡（χ2＝7.294，P＜0.05）、胎膜早破（χ2＝9.397，P＜0.01）、住院天數（χ2＝14.649，P＜0.01）和新生兒重癥鑑護病房（NICU）收治（χ2＝11.050，P＜0.01）是新生兒髮生CRKP定植的危險因素。多因素迴歸分析結果顯示，母親妊娠高血壓綜閤徵（ OR＝9.718，P＜0.01）、胎膜早破（＜24 h）（OR＝6.640，P＜0.01）和NICU收治（OR＝4.119，P＜0.05）是新生兒髮生CRKP定植的獨立危險因素。結論新生兒定植CRKP的耐藥形勢嚴峻。採取措施預防或者緩解母親妊娠高血壓綜閤徵、胎膜早破病情的髮展，加彊NICU細菌耐藥鑑測可減少新生兒髮生CRKP定植，防止耐藥菌播散。
목적：탐토신생인과병방탄청매희류내약폐염극뢰백균（ CRKP ）적내약성급신생인발생CRKP정식적위험인소。방법련속수집2012년1월지2014년6월재천진의과대학제이의원신생인과병방주원、인식자배양결과위폐염극뢰백균적병례자료，공108례。채용병례대조연구방법분량조，병례조위정식CRKP적신생인23례，대조조위정식탄청매희류민감폐염극뢰백균（ CSKP ）적신생인85례。채용χ2검험화Fisher학절개솔법비교량조폐염극뢰백균대21충항균약물적내약성，대량조병례진행단인소급Logistic다인소회귀분석，료해신생인발생CRKP정식적위험인소。결과CRKP대다충청매소류화두포균소류항균약물급복방광알갑오서적내약솔고체100％，대탄청매희류적미라배남화아알배남적내약솔분별위95.7％화87.0％。제대아미잡성、경대매소、배병사성、사배소적민감솔위100％외，CRKP대기타16충항균약물적내약솔균명현고우CSKP（P치균＜0.05）。단인소분석결과현시，사용두포서정（χ2＝20.053，P＜0.01）、흡담（χ2＝15.817，P＜0.01）、위장감압（χ2＝10.731，P＜0.01）、비사（χ2＝15.146，P＜0.01）、침입성조작충류（χ2＝22.572，P＜0.01）、태인출생체질량（χ2＝6.026，P＜0.05）、검출CRKP／CSKP적루계배양차수（χ2＝18.577，P＜0.01）、모친임신고혈압종합정（χ2＝8.698，P＜0.01）、조산（χ2＝4.904，P＜0.05）、산전주원경력（χ2＝8.396，P＜0.01）、소우태령인（χ2＝7.295，P＜0.05）、태령（χ2＝7.294，P＜0.05）、태막조파（χ2＝9.397，P＜0.01）、주원천수（χ2＝14.649，P＜0.01）화신생인중증감호병방（NICU）수치（χ2＝11.050，P＜0.01）시신생인발생CRKP정식적위험인소。다인소회귀분석결과현시，모친임신고혈압종합정（ OR＝9.718，P＜0.01）、태막조파（＜24 h）（OR＝6.640，P＜0.01）화NICU수치（OR＝4.119，P＜0.05）시신생인발생CRKP정식적독립위험인소。결론신생인정식CRKP적내약형세엄준。채취조시예방혹자완해모친임신고혈압종합정、태막조파병정적발전，가강NICU세균내약감측가감소신생인발생CRKP정식，방지내약균파산。
Objective To study drug resistance of carbapenem-resistant Klebsiella pneumonia ( CRKP) in neonates hospitalized in the neonatal unit , and to identify the risk factors for CRKP colonization in neonates .Methods Totally 108 neonates with Klebsiella pneumonia colonization admitted in Department of Neonates , the Second Hospital of Tianjin Medical University during January 2012 and June 2014 were enrolled in the study , including 23 cases with CRKP colonization ( case group ) and 85 cases with carbapenem-sensitive Klebsiella pneumonia (CSKP) colonization (control group).Chi-square test and fisher exact test were used to compare the differences in resistance to 21 antibiotics between CRKP and CSKP . Univariate analysis and Logistic regression analysis were performed to identify the risk factors for CRKP colonization in neonates .Results All of the CRKP strains were resistant to penicillins , cephalosporins and SMZco, and 95.7% and 87.0% of the CRKP strains were resistant to meropenem and imipenem , respectively.All of the CRKP strains were susceptible to amikacin , gentamicin, ciprofloxacin and tetracycline, but were highly resistant to the rest 16 antibiotics compared with CSKP strains (all P<0.05). Univariate analysis showed that 14 factors were associated with CRKP colonization: exposure to cefoxitin (χ2 =20.053, P<0.01), sputum suction (χ2 =15.817, P<0.01), gastrointestinal decompression (χ2 =10.731, P<0.01), nasogastric feeding (χ2 =15.146, P<0.01), invasive procedure (χ2 =22.572, P<0.01), birth weight (χ2 =6.026, P<0.05), frequency of sampling for CRKP/CSKP (χ2 =18.577, P<0.01), hypertension of pregnancy (χ2 =8.698, P<0.01), premature birth (χ2 =4.904, P<0.05), prenatal hospitalization experience (χ2 =8.396, P<0.01), adequacy for gestational age (χ2 =7.295, P<0.05), gestational age (χ2 =7.294, P<0.05), rupture of membranes (χ2 =9.397, P<0.01), length of hospitalization (χ2 =14.649, P<0.01) and admission to the neonatal intensive care unit (NICU) (OR=11.050, P<0.01).Multivariate Logistic regression analysis showed that hypertension of pregnancy (OR=9.718, P<0.01), rupture of membranes ( <24 h) (OR=6.640, P<0.01) and admission to NICU ( OR=4.119, P<0.05) were independent risk factors for CRKP colonization .Conclusions CRKP strains are highly resistant to most antibiotics .Preventing hypertension of pregnancy and rupture of membranes , and monitoring bacterial resistance in NICU may help to reduce the occurrence of CRKP colonization and dissemination .