目的 探讨住院新生儿感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的临床特点、菌株耐药性、感染的危险因素和疾病转归.方法 选取2010年1月至2013年1月宁波市妇女儿童医院新生儿病房产ESBLs大肠埃希菌感染患儿68例(产酶组),选取同期上报的多重耐药菌感染病例中不产ESBLs大肠埃希菌感染新生儿共81例为对照(不产酶组).对分离的产ESBLs大肠埃希菌采用K-B法进行药敏试验.结合患儿出生体质量、胎龄、分娩方式、感染部位和疾病转归等相关临床资料进行分析,采用Logistic回归方法分析新生儿感染产ESBLs大肠埃希菌的危险因素.结果 从68例新生儿采集的样本中,痰液样本产ESBLs大肠埃希菌的分离率最高(49/68,72.1％),其次为血液(7/68,10.3％)和尿液(6/68,8.8％).产ESBLs大肠埃希菌对氨苄西林、头孢噻肟、头孢吡肟和头孢他啶的耐药率均较高(61.8％～100.0％),但对头孢西丁、头孢哌酮/舒巴坦及阿米卡星的耐药率较低(2.9％～10.3％),对碳青霉烯类药物的耐药率均为0.产酶组和不产酶组新生儿均以下呼吸道感染为主.产酶组中,晚期新生儿以下呼吸道感染为主,与早期新生儿比较差异有统计学意义(x2=12.879,P＜0.05).多因素Logistic回归分析发现,胎龄＜37周(Exp (B) =0.352,95％ CI:0.134 ～0.929)、剖宫产(Exp (B)=0.488,95％ CI:0.243 ～0.984)、有侵入性操作(Exp(B)=0.363,95％CI:0.142 ～0.927)、母亲产前一周使用激素和/或抗菌药物(Exp (B) =0.325,95％CI:0.127 ～0.833)是新生儿感染产ESBLs大肠埃希菌的独立危险因素.结论 住院新生儿产ESBLs大肠埃希菌感染以呼吸道为主,感染菌株耐药性强,减少侵入性操作、严格掌握剖宫产以及产前使用激素和抗菌药物指征可减少产ESBLs大肠埃希菌感染的发生.%Objective To investigate clinical features,drug resistance,risk factors and prognosis of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli infection in hospitalized newborns.Methods Sixty eight newborns infected with ESBLs-producing Escherichia coli admitted in Neonatal Ward of Ningbo Women and Children's Hospital during.January 2010 and January 2013 were enrolled in the study; 81 newborns infected with multiple resistant non-ESBLs-producing Escherichia coli served as controls.The drug sensitivity of the isolated ESBLs-producing Escherichia coli was tested using K-B method.Clinical data including birth weight,gestational age,mode of delivery,site of infection and disease outcome were analyzed.Logistic regression analysis was performed to study the risk factors for ESBLs-producing Escherichia coli infection.Results The highest positive rate of ESBLs-producing Escherichia coli was detected in sputum samples (49/68,72.1％),followed by blood (7/68,10.3％) and urine (6/68,8.8％) samples.Strains were highly resistant to ampicillin,cefotaxime,ceftazidime and cefepime (61.8％-100.0％),but the resistant rates to cefoxitin,cefoperazone/sulbactam and amikacin were low (2.9％-10.3％),and were completely sensitive to carbapenems.Lower respiratory tract infections were most popular in both groups,but in ESBLs-producing Escherichia coli infected group,lower respiratory tract infection rate in late newborns was higher than that in early newborns (x2 =12.879,P ＜ 0.05).Multivariate logistic regression analysis showed that gestational age ＜ 37 weeks (Exp (B) =0.352,95％ CI:0.134-0.929),cesarean section (Exp (B) =0.488,95 ％ CI:0.243-0.984),invasive procedures (Exp (B) =0.363,95 ％ CI:0.142-0.927),use of hormones and/or antibiotics one week before birth (Exp (B)=0.325,95％ CI:0.127-0.833) were independent risk factors for ESBLs-producing Escherichia coli infection.Conclusions Respiratory tract infection is popular in ESBLs-producing Escherichia coli infection in hospitalized newborns.The strains are highly resistant to most antibiotics.Reducing invasive procedures,strict control of cesarean section and prenatal use of hormones and antibiotics may reduce the infection of ESBLs-producing Escherichia coli in newborns.
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