标题：新生儿CRKP院内感染性肺炎的危险因素分析

      作者：刘媛 1，王婉霞 2    榆林市第二医院新生儿科 1、质量控制科 2，陕西 榆林 719000

      卷次： 2020年31卷1期

      【摘要】 目的 探讨新生儿获得耐碳青霉烯类肺炎克雷伯菌(CRKP)院内感染性肺炎(HAP)的相关危险因素。方法 选取 2016年 1月至 2019年 6月间在榆林市第二医院出生并接受治疗的 110例肺炎克雷伯菌感染的HAP新生儿作为研究对象，根据患儿耐药情况进行分组，其中45例CRKP患儿纳入观察组，65例碳青霉烯类敏感肺炎克雷伯菌(CSKP)患儿纳入对照组。收集两组患儿的临床资料，并进行单因素和多因素Logistic回归分析，研究HAP新生儿出现CRKP的相关危险因素。结果 单因素分析结果显示，观察组患儿感染前入住NICU比例为31.11%，感染前应用碳青霉烯类抗生素比例为46.67%，明显高于对照组的3.01%和1.54%，差异均具有统计学意义(P<0.05)；观察组患儿母亲产前妊娠期高血压综合征(PIH)比例为33.33%，胎盘早剥比例为15.56%，明显高于对照组的1.54%和0，差异均具有统计学意义(P<0.05)；观察组早产比例为8.89%，明显高于对照组的1.54%，差异具有统计学意义(P<0.05)；观察组母亲产前碳青霉烯类抗生素应用史比例为31.11%，明显高于对照组的4.62%，差异具有统计学意义(P<0.05)；多元回归分析结果显示，患儿感染前入住NICU、患儿感染前应用碳青霉烯类抗生素、患儿母亲产前应用碳青霉烯类抗生素、患儿母亲产前存在PIH为新生儿感染CRKP的独立危险因素(P<0.05)。结论 患儿入住NICU、患儿母亲产前存在PIH、碳青霉烯类抗生素滥用是HAP新生儿发生CRKP的独立危险因素；对于PIH产妇应当及早应用药物控制血压，并采取措施预防胎膜早破、减少抗生素滥用；对出现HAP的新生儿应当合理使用抗生素药物，加强对NICU的细菌检测和控制，防止CRKP感染进一步扩散。
      【关键词】 新生儿；肺炎克雷伯菌；碳青霉烯类抗生素；院内感染性肺炎；危险因素
      【中图分类号】 R722.13+5 【文献标识码】 A 【文章编号】 1003—6350（2020）01—0062—04

Risk factors for nosocomial pneumonia in neonates with carbapenem resistant Klebsiella pneumoniae.
LIU Yuan 1,WANG Wan-xia 2. Department of Neonatology 1, Department of Quality Control 2, the Second Hospital of Yulin City, Yulin719000, Shaanxi, CHINA
【Abstract】 Objective To investigate the risk factors associated with the acquisition of carbapenem resistantKlebsiella pneumoniae (CRKP) hospital-acquired pneumonia (HAP) in Neonatal Intensive Care Unit patients (NICU).Methods A total of 110 HAP neonates infected with Klebsiella pneumoniae who were born and treated in the SecondHospital of Yulin City from January 2016 to June 2019 were selected as subjects. According to the drug resistance of thechildren, 45 children with CRKP were included in the study group, and 65 children with CSKP were included in the con-trol group. The clinical data of the two groups were collected and analyzed, and single factor analysis and multivariate lo-gistic regression analysis were performed to study the risk factors of CRKP in HAP neonates. Results The results ofsingle factor analysis showed that the proportion of NICU and application proportion of carbapenem antibiotics in the ob-servation group before infection were 31.11% and 46.67%, which were significantly higher than corresponding 3.01%and 1.54% in the control group (all P<0.05); the proportion of pregnancy-induced hypertension (PIH) and placental ab-ruption in the observation group were 33.33% and 15.56% , respectively, which were significantly higher than corre-sponding 1.54% and 0 in the control group (P<0.05); the premature birth rate in the observation group was 8.89%, whichwas significantly higher than 1.54% in the control group (P<0.05); the application history of carbapenem antibiotics inthe observation group was 31.11%, which was significantly higher than 4.62% in the control group (P<0.05). Multiple re-gression analysis showed that the independent risk factors of neonatal CRKP infection were admission to NICU beforeinfection, application of carbapenem antibiotics before infection, application of carbapenem antibiotics before delivery,and PIH before delivery (P<0.05). Conclusion The independent risk factors of CRKP in HAP neonates were the chil-dren's admission to NICU, the presence of PIH and carbapenem antibiotics abuse in their mothers before delivery. ForPIH pregnant women, drugs should be used to control blood pressure as early as possible, and measures should be takento prevent premature rupture of membranes and reduce antibiotic abuse. For newborns with HAP, antibiotics should beused reasonably, and bacterial detection and control of NICU should be strengthened to prevent further spread of CRKPinfection.
      【Key words】 Neonates; Klebsiella pneumoniae; Carbapenem antibiotics; Nosocomial pneumonia; Risk factors