儿童多重耐药肺炎克雷伯杆菌脓毒症感染的危险因素分析

Risk factors for multidrug-resistant Klebsiella pneumoniae sepsis in children

摘要:

目的 探讨多重耐药肺炎克雷伯杆菌(MDR-KP)脓毒症感染的危险因素,为防止和减少MDRKP脓毒症的发生以及合理使用抗生素提供参考依据。方法 采用回顾性病例对照研究方法,选取2010 年3 月至2014 年2 月41 例MDR-KP 脓毒症患儿作为病例组,选择同期53 例非MDR-KP 脓毒症患儿作为对照组。采用多元logistic 回归分析对肺炎克雷伯杆菌脓毒症感染的独立危险因素进行评价。结果 病例组感染前PICU 住院天数、感染前机械通气天数、机械通气总天数及感染前抗生素使用天数均明显长于对照组(P<0.05),感染前抗生素使用种类及病死率均明显高于对照组(P<0.05)。Logistic 回归分析结果显示感染前抗生素使用种类及使用三代头孢、碳青霉烯类抗生素是MDR-KP感染的独立危险因素(P<0.05)。结论 合理使用抗生素是防止MDR-KP感染发生的有效措施。

Abstract:

Objective To explore the risk factors for sepsis caused by multidrug-resistant Klebsiella pneumonia (MDR-KP) and to provide a reference for the prevention of MDR-KP sepsis and rational use of antibiotics.Methods A retrospective case-control study of 41 children with MDR-KP sepsis (case group) and 53 pediatric patients without MDR-KP sepsis (control group) between March 2010 and Febrary 2014 was conducted. Multiple logistic regression analysis was performed to estimate the independent risk factors for MDR-KP sepsis.Results Compared with the control group, the case group had a longer length of stay in the PICU before infection (P<0.05), more prolonged duraion of mechanical ventilation before infection (P<0.05), a larger total number of days of mechanical ventilation (P<0.05), more days of antibiotic use before infection (P<0.05), more types of antibiotics used before infection (P<0.05), and a higher mortality (P<0.05). The logistic regression analysis showed that more types of antibiotics used before infection and use of third-generation cephalosporin and carbapenems were independent risk factors for MDR-KP sepsis (P<0.05).Conclusions Rational use of antibiotics is an effective measure to prevent MDR-KP sepsis.