新生儿肺炎合并多重耐药菌感染的影响因素分析

Influencing factors analysis of neonatal pneumonia combined with multiple drug resistant organisms infection

摘要

目的 探讨新生儿肺炎合并多重耐药菌(MDRO)感染的影响因素,为MDRO感染的防治提供依据。方法 选取2018年6月至2023年6月首都儿科研究所附属儿童医院收治的211例新生儿肺炎患儿为研究对象,根据入院后3天内是否发生MDRO感染分为感染组(n=40)和未感染组(n=171).查阅两组患儿的电子病例档案,获取一般资料及实验室资料,采用单因素、多因素Logistic回归分析研究新生儿肺炎合并MDRO感染的影响因素。结果 单因素分析结果显示,感染组早产、出生体重<2500g、肠外营养、机械通气、联合使用抗菌药物种类≥3种、抗菌药物使用时间>7天占比高于未感染组,差异有统计学意义(χ²值介于3.917~8.268之间,P<0.05);多因素Logistic回归分析结果显示,早产、出生体重<2500g、肠外营养、机械通气、联合使用抗菌药物≥3种、使用抗菌药物时间>7天是新生儿肺炎合并MDRO感染的危险因素(OR值介于4.305~9.010之间,P<0.05);根据Logistic回归模型获得新生儿肺炎发生MDRO感染的预测概率P,绘制受试者工作特征曲线,结果显示,该模型预测新生儿肺炎合并MDRO感染的曲线下面积为0.817,95%CI为0.749~0.884,P<0.001。结论 早产、出生体重<2500g、肠外营养、机械通气、联合使用抗菌药物≥3种、使用抗菌药物时间>7天均是新生儿肺炎合并MDRO感染的危险因素,且根据上述影响因素构建的风险模型对新生儿肺炎合并MDRO感染具有良好的预测价值,可为MDRO感染的预测提供依据.

Abstract

Objective To explore the influencing factors of neonatal pneumonia combined with multiple drug resistant organisms (MDRO) infection and provide a basis for the prevention and treatment of MDRO infection. Methods A total of 211 neonatal pneumonia patients admitted to the Children's Hospital Affiliated to Capital Institute of Pediatrics from June 2018 to June 2023 were selected as the research subjects. According to whether MDRO infection occurred within 3 days after admission, they were divided into infection group (n=40) and non-infection group (n=171). The electronic medical records of the two groups of children were consulted to obtain general and laboratory data. Univariate and multivariate Logistic regression analysis were used to study the influencing factors of neonatal pneumonia combined with MDRO infection. Results The results of univariate analysis showed that the incidence of premature birth, birth weight <2500g, parenteral nutrition, mechanical ventilation, combined use of ≥3 types of antibiotics, and use of antibiotics for >7 days in the infection group was higher than that in the non-infection group, and the difference was statistically significant (χ ²=3.917-8.268, P<0.05). The results of multivariate Logistic regression analysis showed that premature birth, birth weight <2500g, parenteral nutrition, mechanical ventilation, combined use of ≥3 types of antibiotics, and use of antibiotics for >7 days were risk factors for neonatal pneumonia combined with MDRO infection (OR=4.305-9.010, P<0.05). The predicted probability P of neonatal pneumonia with MDRO infection was obtained according to the Logistic regression model, and the receiver operating characteristic curve was drawn. The results showed that the area under the curve of the model for predicting neonatal pneumonia combined with MDRO infection was 0.817, with a 95% CI of 0.749 to 0.884, P<0.001. Conclusion Premature birth, birth weight <2500g, parenteral nutrition, mechanical ventilation, combined use of ≥3 antibiotics, and use of antibiotics for >7 days are risk factors for neonatal pneumonia combined with MDRO infection. The risk model constructed based on the above influencing factors has a good predictive value for neonatal pneumonia combined with MDRO infection, which can provide a basis for the prediction of MDRO infection.

关键词

新生儿 / 肺炎 / 多重耐药菌感染 / 影响因素 / 预测模型

Key words

neonate / pneumonia / multidrug-resistant bacterial infection / influencing factors / prediction model

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基金资助

北京市自然科学基金项目(L202022)