新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危险因素分析

Risk factors for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae colonization in neonates

摘要:

目的 探讨新生儿重症监护室（NICU）新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌（KPC-Kp）定植的危险因素。方法 采用病例对照研究方法，病例组为NICU 住院新生儿中有KPC-Kp 定植的新生儿9 例，随机选取同期NICU 无该菌定植的新生儿18 例作为对照组。对两组行单因素及logistic 多因素回归分析了解定植KPC-Kp 的危险因素。结果 单因素分析显示有统计学意义的因素有：出生胎龄、出生体重、住院天数、呼吸机使用时间、先天性心脏病、经外周静脉穿刺中心静脉插管、外科手术、静脉营养时间、使用碳青霉烯类抗生素及使用时间、使用糖肽类抗生素。Logistic 多因素回归分析显示碳青霉烯类抗生素使用时间（>4 d）是NICU 新生儿定植KPC-Kp 的独立危险因素（OR=18.7，95%CI：1.98~175.5，P=0.01）。控制该菌定植方法包括对定植KPC-Kp 新生儿的隔离、监测以及抗生素的合理使用。结论 较长时间使用碳青霉烯类抗生素是NICU新生儿发生KPC-Kp 定植的独立危险因素。

Abstract:

Objective To identify risk factors for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) colonization in neonates hospitalized in the neonatal intensive care unit (NICU). Methods A case-control study was conducted. The case group included nine patients colonized with KPC-Kp between 1 August 2012 and 31 April 2013 and the controls were selected randomly from patients without KPC-Kp colonization during the same period. Univariable analysis and multivariable logistic regression analysis were conducted to identify risk factors for KPC-Kp colonization. Results The univariable analysis showed 11 factors associated with KPC-Kp colonization:gestational age, birth weight, length of hospital stay, duration of mechanical ventilation, congenital heart disease,peripherally inserted central catheter, surgical operation, duration of intravenous nutrition, carbapenems use, duration of carbapenems use and glycopeptides use. The multivariable logistic regression analysis showed that exposure to more than 4 days of carbapenems use (OR=18.7, 95%CI: 1.98-175.5, P=0.01) was an independent risk factor for KPCKp colonization. The intervention to control KPC-Kp colonization included contact isolation, active surveillance, and rational use of antibiotics. Conclusions Exposure to prolonged use of carbapenems is an independent risk factor for the development of KPC-Kp colonization in neonates hospitalized in the NICU.