目的 探究儿童耐碳青霉烯类铜绿假单胞菌（carbapenem-resistant Pseudomonas aeruginosa, CRPA）感染的临床特点，分析感染的危险因素。 方法 回顾性纳入2018年1月—2023年9月在中国医科大学深圳市儿童医院住院的CRPA感染患儿60例作为CRPA组，随机选取同期碳青霉烯类敏感铜绿假单胞菌感染患儿82例作为对照组。采用多因素logistic回归分析探讨CRPA感染的危险因素。 结果 CRPA感染患儿主要分布在重症监护病房（intensive care unit, ICU）（52%，31/60），检出部位主要来源于下呼吸道（53%，32/60）。单因素分析显示，性别、1年内侵袭性治疗史、入院前使用抗生素、有基础性疾病史、入住ICU、入院后接受侵入性操作、抗生素应用时间>14 d及抗生素应用种类≥3种与CRPA感染有关（P<0.05）。多因素分析显示，1年内侵袭性治疗史（OR=3.228）、入院前使用抗生素（OR=4.052）、抗生素应用时间>14 d（OR=4.961）及抗生素应用种类≥3种（OR=3.687）是儿童感染CRPA的独立危险因素（P<0.05）。 结论 儿童CRPA感染可能与1年内侵袭性治疗史、入院前抗生素应用、入院后抗生素使用时间及抗生素使用种类多样性相关。
Abstract
Objective To investigate the clinical characteristics of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection in children and the risk factors for such infection. Methods A retrospective analysis was conducted among 60 children with CRPA infection (CRPA group) who were hospitalized in Shenzhen Children's Hospital, China Medical University, from January 2018 to September 2023, and 82 children with carbapenem-sensitive Pseudomonas aeruginosa infection during the same period were randomly selected as the control group. A multivariate logistic regression analysis was used to investigate the risk factors for CRPA infection. Results Among the 60 children with CRPA infection, 31 (52%) were admitted to the intensive care unit (ICU), and the lower respiratory tract was the main detection site in 32 children (53%). The univariate analysis showed that sex, history of invasive treatment within 1 year, antibiotic use before admission, presence of underlying condition, ICU admission, invasive procedure after admission, antibiotic use for >14 days, and the type of antibiotics used of ≥3 were associated with CRPA infection (P<0.05). The multivariate logistic regression analysis showed that the history of invasive treatment within 1 year (OR=3.228, P<0.05), antibiotic use before admission (OR=4.052, P<0.05), antibiotic use for >14 days (OR=4.961, P<0.05), and the type of antibiotics used of ≥3 (OR=3.687, P<0.05) were independent risk factors for CRPA infection in children. Conclusions CRPA infection in children may be associated with a history of invasive treatment within the past year, antibiotic use before admission, duration of antibiotic use after admission, and the diversity of antibiotic types used.
关键词
耐碳青霉烯类铜绿假单胞菌 /
临床特点 /
危险因素 /
儿童
Key words
Carbapenem-resistant Pseudomonas aeruginosa /
Clinical characteristic /
Risk factor /
Child
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基金
广东省高水平临床重点专科（深圳市配套建设经费）项目（SZGSP012）；高水平医院-广东省儿童感染精准诊断工程技术研究中心（2021B295）；深圳市“医疗三名工程”项目（SZSM202311024）。
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