目的 调查儿童专科医院住院患儿碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumonia，CRKP）感染及死亡的危险因素，为该类细菌的感染防治提供参考依据。 方法 采用配对病例-病例-对照研究的方法。回顾性纳入昆明市儿童医院2019年1月至2021年10月的81例CRKP感染患儿，81例碳青霉烯类敏感肺炎克雷伯菌（carbapenem-sensitive Klebsiella pneumonia，CSKP）感染患儿，及162例对照儿童（住院期间未分离出CRKP及CSKP的患儿），比较分析各组儿童的基础疾病、既往住院暴露及该次住院暴露情况与CRKP感染及死亡的关联性。 结果 与对照组比较，既往3个月内有住院史与CRKP、CSKP感染存在较高关联强度（分别OR=14.25、10.07，P<0.01）；CRKP感染患儿特异的危险因素包括既往3个月内有碳青霉烯药物治疗史（OR=16.54，P<0.01）及该次住院接受中心静脉置管（OR=33.03，P<0.01）。而既往3个月内有碳青霉烯药物治疗史（OR=28.33，P<0.01）及该次住院抗生素经验性用药（OR=14.50，P<0.01）是导致CRKP患儿死亡的危险因素。 结论 患儿既往3个月内有住院史、碳青霉烯类药物治疗史，以及入院后接受侵入性操作是影响CRKP感染及预后的主要原因。儿童专科医院有必要开展入院时CRKP主动筛查，规范使用抗生素，并加强医院感染监测，以控制CRKP感染的发生。 ［中国当代儿科杂志，2022，24（9）：1008-1013］
Abstract
Objective To identify risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and death in hospitalized children in pediatric hospitals, and to provide a basis for the prevention and control of such infection. Methods This is a matched case-case-control study. The medical data of 81 children with CRKP infection and 81 children with carbapenem-sensitive Klebsiella pneumoniae (CSKP) infection who were hospitalized in Kunming Children's Hospital from January 2019 to October 2021 were retrospectively analyzed. A total of 162 children without CRKP or CSKP infection were enrolled as the control group. The association of underlying disease, previous hospitalization exposure, and current hospitalization exposure with CRKP infection and death was identified. Results Compared with the control group, there was a higher correlation between the history of hospitalization in the past 3 months and CRKP and CSKP infections (OR=14.25 and 10.07 respectively, P<0.01). The use of carbapenem in the past 3 months (OR=16.54, P<0.01) and central venous catheterization during the current hospitalization (OR=33.03, P<0.01) were risk factors for CRKP infection. The use of carbapenem in the past 3 months (OR=28.33, P<0.01) and empirical antibiotic use during the current hospitalization (OR=14.5, P<0.01) were risk factors for death of the children with CRKP infection. Conclusions The history of hospitalization and the history of treatment with carbapenems in the past 3 months and invasive procedure after admission are leading influencing factors for CRKP infection and prognosis. It is necessary for pediatric hospitals to conduct CRKP screening on admission, standardize antibiotic use, and strengthen nosocomial infection surveillance, so as to decrease the incidence of CRKP infection. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 1008-1013
关键词
碳青霉烯耐药肺炎克雷伯菌 /
病例-病例-对照研究 /
危险因素 /
儿童
Key words
Carbapenem-resistant Klebsiella pneumoniae /
Case-case-control study /
Risk factor /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 喻华, 徐雪松, 李敏, 等. 肠杆菌目细菌碳青霉烯酶的实验室检测和临床报告规范专家共识[J]. 中国感染与化疗杂志, 2020, 20(6): 671-680. DOI: 10.16718/j.1009-7708.2020.06.015.
2 CHINET中国细菌耐药监测网. 肺炎克雷伯菌对碳青霉烯类耐药变迁[EB/OL]. [2021-04-06]. https://www.chinets.com/Data/GermYear.
3 郑少微, 李萍, 张正良, 等. 2005-2017年中国CHINET常见革兰阴性菌对碳青霉烯类抗生素耐药的监测结果[J]. 临床急诊杂志, 2019, 20(1): 40-44. DOI: 10.13201/j.issn.1009-5918.2019.01.008.
4 杨欣, 鲁利群, 黄莉, 等. 儿科碳青霉烯类耐药肺炎克雷伯菌感染危险因素及其耐药性[J]. 中华医院感染学杂志, 2020, 30(22): 3470-3473. DOI: 10.11816/cn.ni.2020-206730.
5 许渝, 黄砚屏, 罗万军. 新生儿耐碳青霉烯类肠杆菌感染影响因素[J]. 中国感染控制杂志, 2020, 19(12): 1098-1101. DOI: 10.12138/j.issn.1671-9638.20206029.
6 Kaye KS, Harris AD, Samore M, et al. The case-case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance[J]. Infect Control Hosp Epidemiol, 2005, 26(4): 346-351. PMID: 15865269. DOI: 10.1086/502550.
7 Zheng B, Dai Y, Liu Y, et al. Molecular epidemiology and risk factors of carbapenem-resistant Klebsiella pneumoniae infections in eastern China[J]. Front Microbiol, 2017, 8: 1061. PMID: 28659886. PMCID: PMC5468447. DOI: 10.3389/fmicb.2017.01061.
8 Guzman-Cottrill JA, Kirby A. Healthcare-associated infections in the pediatric intensive care unit[J]. J Pediatr Intensive Care, 2014, 3(4): 281-289. PMID: 31214474. PMCID: PMC6530765. DOI: 10.3233/PIC-14110.
9 何方. 某医院呼吸科耐碳青霉烯类药物肺炎克雷伯菌感染危险因素分析[J]. 中国农村卫生, 2020, 12(22): 36-37. DOI: 10.3969/j.issn.1674-361X.2020.22.036.
10 田丽丽, 王珊珊, 赵建平, 等. 肺部耐碳青霉烯类肺炎克雷伯菌感染/定植患者死亡的相关危险因素分析[J]. 中国医药导报, 2021, 18(8): 118-121.
11 马永驰, 汤丽莉, 王雪敏. ICU内碳青霉烯类耐药肺炎克雷伯菌感染的危险因素及预测模型的建立[J]. 临床肺科杂志, 2021, 26(7): 1030-1034. DOI: 10.3969/j.issn.1009-6663.2021.07.014.
12 岳彩妮, 唐思慧, 杨万春. 回顾性分析安徽省某三甲医院耐碳青霉烯类肺炎克雷伯菌感染死亡的危险因素[J]. 临床肺科杂志, 2022, 27(5): 706-711. DOI: 10.3969/j.issn.1009-6663.2022.05.013.
13 陈蕾, 田俊华, 贾磊, 等. 重症监护室内医院获得性耐碳青霉烯类肺炎克雷伯菌肺炎的危险因素分析[J]. 国际流行病学传染病学杂志, 2020, 47(3): 231-234. DOI: 10.3760/cma.j.cn331340-20191009-00173.
14 温世宝, 许磊, 从人愿, 等. 耐碳青霉烯类肺炎克雷伯菌感染危险因素分析[J]. 华北理工大学学报(医学版), 2022, 24(2): 107-112. DOI: 10.19539/j.cnki.2095-2694.2022.02.004.
15 杨健. 院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析[J]. 吉林医学, 2021, 42(1): 59-61. DOI: 10.3969/j.issn.1004-0412.2021.01.018.
16 朱敬蕊, 段缓, 崔琢, 等. 成年住院病人感染耐碳青霉烯类肺炎克雷伯菌的危险因素研究[J]. 蚌埠医学院学报, 2021, 46(9): 1201-1203. DOI: 10.13898/j.cnki.issn.1000-2200.2021.09.012.
17 温伟, 艾效曼, 陈曦, 等. 2017～2019年某医院急诊科碳青霉烯类耐药肺炎克雷伯菌分布及危险因素[J]. 中国急救医学, 2021, 41(10): 874-878. DOI: 10.3969/j.issn.1002-1949.2021.10.008.
18 Chang D, Sharma L, Dela Cruz CS, et al. Clinical epidemiology, risk factors, and control strategies of Klebsiella pneumoniae infection[J]. Front Microbiol, 2021, 12: 750662. PMID: 34992583. PMCID: PMC8724557. DOI: 10.3389/fmicb.2021.750662.
19 殷丽军, 杨韦菁, 缪瑾, 等. 新生儿重症监护患者耐碳青霉烯类肺炎克雷伯菌定植发展为感染的危险因素分析[J]. 中国感染控制杂志, 2022, 21(1): 15-21. DOI: 10.12138/j.issn.1671-9638.20221768.
20 吴宁俊, 林德, 王伟. 重症监护室住院患者肠道耐碳青霉烯类肠杆菌筛查及干预效果评价[J]. 中国消毒学杂志, 2021, 38(9): 716-718. DOI: 10.11726/j.issn.1001-7658.2021.09.023.
21 Yang Y, Liu J, Muhammad M, et al. Factors behind the prevalence of carbapenem-resistant Klebsiella pneumoniae in pediatric wards[J]. Medicine (Baltimore), 2021, 100(36): e27186. PMID: 34516520. PMCID: PMC8428699. DOI: 10.1097/MD.0000000000027186.
22 张莉, 陈媛, 王义俊, 等. 重症监护室患者耐碳青霉烯类肺炎克雷伯菌感染危险因素分析[J]. 中国医院药学杂志, 2020, 40(23): 2459-2463. DOI: 10.13286/j.1001-5213.2020.23.12.
23 路简羽, 贾会学, 赵秀莉, 等. 耐碳青霉烯类肺炎克雷伯菌医院感染及定植危险因素[J]. 中华医院感染学杂志, 2022, 32(6): 830-834. DOI: 10.11816/cn.ni.2022-212527.
24 Gómez Rueda V, Zuleta Tobón JJ. Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae: a case-case-control study[J]. Colomb Med (Cali), 2014, 45(2): 54-60. PMID: 25100889. PMCID: PMC4123582.
25 Logan LK, Nguyen DC, Scaggs Huang FA, et al. A multi-centered case-case-control study of factors associated with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections in children and young adults[J]. Pediatr Infect Dis J, 2019, 38(5): 490-495. PMID: 30169484. PMCID: PMC6395555. DOI: 10.1097/INF.0000000000002176.
26 陈虹宇, 黄双双, 孙丽芳, 等. 儿童检出耐碳青霉烯类肺炎克雷伯菌的影响因素分析[J]. 检验医学与临床, 2021, 18(2): 168-171. DOI: 10.3969/j.issn.1672-9455.2021.02.007.
27 潘芬, 张泓. 儿童感染耐碳青霉烯类肺炎克雷伯菌的现状与对策[J]. 中华检验医学杂志, 2020, 43(5): 525-528. DOI:10.3760/cma.j.cn114452-20191128-00695.
基金
云南省教育厅科学研究基金（2022J0257）；云南省中青年学术和技术带头人（202005AC160066）；昆明市“春城计划”青年人才专项。
PDF(594 KB)
