Department of Pediatrics, Columbia University, New York, NY 10032, USA.
Infect Control Hosp Epidemiol. 2012 Jun;33(6):602-7. doi: 10.1086/665709. Epub 2012 Apr 13.
The purpose of this study was to describe patterns of infection or colonization with antibiotic-resistant gram-negative bacilli (GNB) in hospitalized children utilizing an electronic health record.
Tertiary care facility.
Pediatric patients 18 years of age or younger hospitalized from January 1, 2006, to December 31, 2008.
Children were identified who had (1) at least 1 positive culture for a multidrug-resistant (MDR) GNB, defined as a GNB with resistance to 3 or more antibiotic classes; or (2) additive drug resistance, defined as isolation of more than 1 GNB that collectively as a group demonstrated resistance to 3 or more antibiotic classes over the study period. Differences in clinical characteristics between the 2 groups were ascertained, including history of admissions and transfers, comorbid conditions, receipt of procedures, and antibiotic exposure.
Of 56,235 pediatric patients, 46 children were infected or colonized with an MDR GNB, of which 16 were resistant to 3 classes and 30 were resistant to 4 classes. Another 39 patients had positive cultures for GNB that exhibited additive drug resistance. Patients with additive drug resistance were more likely than patients with MDR GNB to have had previous admissions to a long-term facility (8 vs 2; P = .04) and had more mean admissions (7 vs 3; P < .01) and more mean antibiotic-days (P < .01 to P = .02). Six patients with additive drug resistance later had a positive culture with an MDR GNB.
An electronic health record can be used to track antibiotic class resistance in GNB isolated from hospitalized children over multiple cultures and hospitalizations.
本研究旨在利用电子病历描述住院儿童中抗生素耐药革兰氏阴性杆菌（GNB）感染或定植的模式。
三级保健设施。
2006 年 1 月 1 日至 2008 年 12 月 31 日住院的 18 岁或 18 岁以下的儿科患者。
确定至少有 1 种多药耐药（MDR）GNB 阳性培养物的儿童（1），定义为对 3 种或 3 种以上抗生素类别具有耐药性的 GNB；或（2）附加药物耐药性，定义为在研究期间分离出超过 1 种 GNB，这些 GNB 共同具有对 3 种或 3 种以上抗生素类别的耐药性。比较两组患儿的临床特征差异，包括住院和转科次数、合并症、接受的操作和抗生素暴露情况。
在 56235 名儿科患者中，有 46 名患儿感染或定植了 MDR GNB，其中 16 名患儿对 3 类药物耐药，30 名患儿对 4 类药物耐药。另外 39 名患者的 GNB 培养物呈附加药物耐药。与 MDR GNB 患儿相比，具有附加药物耐药性的患儿更有可能之前曾在长期护理机构住院（8 例 vs 2 例；P =.04），平均住院次数更多（7 例 vs 3 例；P <.01），平均使用抗生素天数更多（P <.01 至 P =.02）。6 名具有附加药物耐药性的患者后来有 1 例 MDR GNB 阳性培养物。
电子病历可用于跟踪在多次培养和住院期间从住院儿童分离的 GNB 中抗生素类别的耐药性。
