Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: a prospective cohort study.
Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: a prospective cohort study.
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DOI：
10.1155/2013/756209
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发表时间：
2013
影响因子：
--
通讯作者：
Dubey NK
中科院分区：
文献类型：
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作者：
Vijayakanthi N;Bahl D;Kaur N;Maria A;Dubey NK
这项前瞻性队列研究旨在确定印度北部一家三级医院新生儿重症监护室中产超广谱β-内酰胺酶（ESBL-）微生物、各种产ESBL细菌引起的感染频率、这些微生物的抗生素敏感性以及与这些感染相关的风险因素。在入组研究的150名新生儿中，47名培养阳性新生儿被纳入研究队列，并分为两组：ESBL阳性（8名新生儿）和ESBL阴性（39名新生儿）队列。从这47名新生儿的72份培养样本中分离出各种微生物。其中，10份培养样本生长ESBL阳性微生物，62份样本生长ESBL阴性微生物。产ESBL菌的频率为5.3%。发现ESBL感染发病率密度为3.4/1000患者-天。产ESBL菌以克雷伯菌属最多（60%），其次为大肠埃希菌（30%）和假单胞菌属（10%）。80%产ESBL菌对哌拉西林-他唑巴坦敏感。单因素分析发现有意义的危险因素（P < 0.05）为早产、低出生体重、围产期窒息、呼吸窘迫综合征、贫血、代谢性酸中毒、机械通气时间延长（>7天）、住院时间、3级住院时间、既往抗生素使用、中心静脉导管持续时间、外周插入中心静脉导管持续时间和全肠外营养持续时间。Logistic回归模型中保持显著性的因素是住院时间（校正OR：0.958，CI：0.920-0.997，P值= 0.037）和胎龄（校正OR：1.39，CI：1.037-1.865，P值= 0.028）。两组死亡率无显著差异。
This prospective cohort study was conducted to determine the frequency of infections caused by extended-spectrum beta-lactamase- (ESBL-) producing organisms, various bacteria producing ESBL, antibiotic susceptibility of these organisms, and the risk factors associated with these infections in a neonatal intensive care unit in a tertiary care hospital in North India. Of the 150 neonates enrolled in the study, 47 culture-positive neonates were included in the study cohort and were divided into two groups: ESBL-positive (8 neonates) and ESBL-negative (39 neonates) cohorts. Various organisms were isolated from 72 culture samples in these 47 neonates. Of these, 10 culture samples grew ESBL-positive organisms and 62 samples grew ESBL-negative organisms. The frequency of ESBL-producing organisms was found to be 5.3%. ESBL infection incidence densities were found to be 3.4 per 1000 patient-days. Klebsiella (60%) was the most common organism producing ESBL followed by Escherichia coli (30%) and Pseudomonas (10%). Eighty percent of the ESBL-producing organisms were sensitive to piperacillin-tazobactam. Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration. Factors that retained significance in the logistic regression model were duration of hospital stay (adjusted OR: 0.958, CI: 0.920–0.997, and P value = 0.037) and gestational age (adjusted OR: 1.39, CI: 1.037–1.865, and P value = 0.028). There was no significant difference in the mortality between the two groups.