Risk factors and prevention measures of multiple drug-resistant infections in neonatal intensive care unit
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摘要: 目的 探讨新生儿重症监护病房(NICU)多重耐药菌(MDRO)感染的危险因素,为临床制定预防控制措施提供科学依据。 方法 选取2012年1月-2016年12月海南省妇幼保健院NICU收治的326例感染患儿,根据其药敏试验结果分为MDRO感染组(102例)和非MDRO感染组(224例),分析多重耐药菌的检出情况。应用单因素及多因素Logistic回归分析NICU多重耐药菌感染的危险因素。 结果 NICU多重耐药菌感染数量呈逐年上升趋势。102例MDRO感染患儿检出MDRO菌株156株,MDRO检出数量居前3位的是MDR/PDR-PA 60株(38.46%),MRSA 45株(28.85%),CR-AB 37株(23.72%)。MDRO感染部位主要以呼吸道感染及血流感染为主。单因素及多因素Logistic回归分析显示,出生体质量(OR=2.581,P=0.026)、昏迷(OR=3.846,P=0.038)、有创机械通气(OR=4.317,P<0.001)、使用抗菌药物种类(OR=5.218,P<0.001)及使用抗菌药物时间(OR=2.615,P=0.032)是NICU多重耐药菌感染的独立危险因素。 结论 NICU患儿多重耐药菌感染的危险因素较多,应尽早采取防控措施,以降低多重耐药菌感染发生率。Abstract: Objective To investigate the risk factors of multiple drug-resistant infections(MDRO) in neonatal intensive care unit (NICU), and to provide scientific evidence for clinical prevention and control measures. Methods From January, 2012 to December, 2016 in Hainan Province Maternal and child health hospital treated 326 cases of NICU infection in children, according to the results of drug sensitive test for MDRO infection group (102 cases) and non MDRO infection group (224 cases), analysis of prevalence of multidrug-resistant bacteria. Single factor and multi factor Logistic regression analysis were used to analyze the risk factors of NICU multiple drug-resistant infections. Results From 2012 to 2016, the number of NICU multiple drug-resistant infections in our hospital showed an increasing trend year by year. One hundred and fifty-six strains of MDRO were detected in 102 children with MDRO infection. The number of MDRO detected in the top three was MDR/PDR-PA 60strain (38.46%), MRSA 45 strain (28.85%), CR-AB 37 strain (23.72%). The main sites of MDRO infection are respiratory tract infection and bloodstream infection. Univariate and multivariate Logistic regression analysis showed that birth weight (OR=2.581, P=0.026), coma (OR=3.846, P=0.038), invasive mechanical ventilation (OR=4.317, P<0.001), types of antibacterial drugs (OR=5.218, P<0.001) and antimicrobial use time (OR=2.615, P=0.032) were independent risk factors multiple drug-resistant infections in NICU. Conclusion There are many risk factors for multiple drug-resistant infections in children with NICU, and prevention and control measures should be taken as early as possible to reduce the incidence of multiple drug-resistant infections.
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