儿童碳青霉烯类耐药肺炎克雷伯菌医院感染的危险因素分析：单中心配对病例-病例-对照研究

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］

Risk factors for nosocomial infection of carbapenem-resistant Klebsiella pneumoniae in children: a single-center matched case-case-control study

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