MDRO感染的重症肺炎患儿抗菌疗效影响因素分析OA
Analysis of factors influencing antibacterial efficacy in children with severe pneumonia infected by MDRO
目的 探讨多重耐药菌(multidrug-resistant organism,MDRO)感染的重症肺炎患儿抗菌疗效的影响因素.方法 采用回顾性研究方法,收集 2020 年 1 月至 2022 年 10 月安顺市人民医院收治的 75 例MDRO感染的重症肺炎患儿的临床资料,记录MDRO病原菌特征及主要病原菌耐药性,选取敏感抗菌药物治疗.根据抗菌疗效将患儿分为有效组(n=19)和无效组(n=56),收集 2 组患儿的一般资料、实验室指标[白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)、中性粒细胞计数].采用多因素Logistic回归分析评价患儿抗菌疗效的影响因素,受试者工作特征(receiver operating characteristic,ROC)曲线和决策曲线评估实验室指标的预测效能和临床效用.统计学方法采用t检验、χ2 检验.结果 75 例患儿共培养出 80 株MDRO菌株,其中真菌12 株(15.00%),革兰氏阴性菌 50 株(62.50%),革兰氏阳性菌 18 株(22.50%);主要耐药菌显示,鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌对氨苄西林、头孢噻肟为全耐药,对头孢曲松、哌拉西林/他唑巴坦、头孢哌酮钠舒巴坦钠为高度耐药;表皮葡萄球菌、金黄色葡萄球菌对万古霉素、红霉素为全耐药.无效组患儿既往应用抗菌药物、有创机械通气、儿童重症监护病房(pediatric intensive care unit,PICU)入住时间≥7 d、肠外营养比例高于有效组[47.37%(9/19)与 23.21%(13/56),31.58%(6/19)与 8.93%(5/56),89.47%(17/19)与10.71%(6/56),31.58%(6/19)与8.93%(5/56),χ2 值分别为3.993、4.146、37.767、4.146,P值均<0.05];无效组的PCT、WBC、中性粒细胞计数、CRP水平均高于有效组[(15.56±4.66)µg/L与(10.81±3.24)µg/L,(12.26±3.60)×109/L 与(8.55±2.57)×109/L,(4.45±1.30)×109/L 与(3.11±0.93)×109/L,(72.72±20.82)µg/L与(51.98±15.60)µg/L,t值分别为4.912、4.888、4.883、4.585,P值均<0.05];调整后的多因素Logistic回归分析结果显示,血清PCT、WBC、中性粒细胞计数、CRP水平是MDRO感染的重症肺炎患儿抗菌失败的高危因素(P<0.05).结论 MDRO感染的重症肺炎患儿病原菌主要为革兰氏阴性菌,表皮葡萄球菌、金黄色葡萄球菌对万古霉素、红霉素有较高耐药性;此外,血清PCT、WBC、中性粒细胞计数、CRP水平诊断MDRO感染的重症肺炎抗菌疗效具有较好的预测价值和临床适用性.
Objective To investigate the influencing factors of antibacterial efficacy in children with severe pneumonia infected by multidrug-resistant organism(MDRO).Methods The clinical data of 75 children with severe pneumonia infected by MDRO admitted to Anshun City People's Hospital from January 2020 to October 2022 were retrospectively analyzed.The characteristics of MDRO pathogens and the drug resistance of main pathogens were recorded,and sensitive antibiotics were selected for treatment.According to the antibacterial efficacy,the children were divided into effective group(n=19)and ineffective group(n=56).The general data and laboratory indicators[white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP)and neutrophil count]of the two groups were collected.Multivariate Logistic regression analysis was used to identify the factors influencing the antibacterial efficacy in children.The predictive performance and clinical utility of laboratory indicators were evaluated by the receiver operating characteristic(ROC)curve and decision curve.Statistical analysis was performed using t-test,χ2 test.Results A total of 80 MDRO strains were cultured in 75 children,including 12 strains of fungi(15.00%),50 strains of Gram-negative bacteria(62.50%),and 18 strains of Gram-positive bacteria(22.50%).The main drug-resistant bacteria showed that Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa were completely resistant to Ampicillin and Cefotaxime,and highly resistant to Ceftriaxone,Piperacillin/Tazobactam and Cefoperazone-Sulbactam.Staphylococcus epidermidis and Staphylococcus aureus were fully resistant to Vancomycin and Erythromycin.The proportion of previous antibiotic use,invasive mechanical ventilation,the length of stay in the pediatric intensive care unit(PICU)≥7 d,and parenteral nutrition in the ineffective group were higher than those in the effective group[47.37%(9/19)vs 23.21%(13/56),31.58%(6/19)vs 8.93%(5/56),89.47%(17/19)vs 10.71%(6/56),31.58%(6/19)vs 8.93%(5/56),χ2 values were 3.993,4.146,37.767,4.146,respectively;all P<0.05].The levels of PCT,WBC,neutrophil count,and CRP in the ineffective group were higher than those in the effective group[(15.56±4.66)µg/L vs(10.81±3.24)µg/L,(12.26±3.60)×109/L vs(8.55±2.57)×109/L,(4.45±1.30)×109/L vs(3.11±0.93)×109/L,(72.72±20.82)µg/L vs(51.98±15.60)µg/L,respectively;t values were 4.912,4.888,4.883,4.585,respectively;all P<0.05]After adjustment,multivariate Logistic regression analysis showed that the levels of serum PCT,WBC,neutrophil count,and CRP were the high-risk factors for antibacterial failure in children with severe pneumonia infected by MDRO(P<0.05).Conclusion The main pathogens in children with severe pneumonia infected by MDRO are Gram-negative bacteria,with Staphylococcus epidermidis and Staphylococcus aureus exhibiting high resistance to Vancomycin and Erythromycin.Furthermore,the levels of serum PCT,WBC,neutrophil count,and CRP demonstrate considerable predictive value and clinical applicability in evaluating the antibacterial efficacy for severe pneumonia infected by MDRO.
蒋训楠;朱晓萍;欧阳洁;卢群;胡伟博
贵州医科大学,贵州 贵阳 550000贵州医科大学,贵州 贵阳 550000安顺市人民医院 儿科,贵州 安顺 561000安顺市人民医院 儿科,贵州 安顺 561000安顺市人民医院 儿科,贵州 安顺 561000
多重耐药菌重症肺炎病原学特征实验室指标耐药性
Multidrug-resistant organismSevere PneumoniaEtiological characteristicLaboratory indicatorsDrug resistance
《发育医学电子杂志》 2026 (1)
1-7,27,8
贵州省科技计划[黔科合支撑(2020)4Y124号]
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