Yin L, He L, Miao J, Yang W, Wang X, Ma J, Wu N, Cao Y, Wang C
Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China.
Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China.
Infect Prev Pract. 2021 May 12;3(3):100147. doi: 10.1016/j.infpip.2021.100147. eCollection 2021 Sep.
Colonization has been reported to play an important role in carbapenem-resistant Enterobacterales (CRE) infection; however, the extent to which carriers develop clinical CRE infection and related risk factors in neonatal intensive care unit (NICU) patients is unclear.
To investigate the frequency of CRE colonization and its contribution to infections in NICU patients.
CRE colonization screening and CRE infection surveillance were performed in the NICU in 2017 and 2018.
Among 1230 unique NICU patients who were screened for CRE colonization, 144 patients tested positive (11.7%, 144/1230), with 9.2% (110/1197) in the intestinal tract, which was higher than that in the upper respiratory tract (6.6%, 62/945) (=0.026). Gestational age, low birth weight and prolonged hospitalization were risk factors for CRE colonization (all <0.001). Diversilab homology monitoring found an overall 17.4% (25/144) risk of infection among patients colonized with CRE. For carbapenem-resistant Klebsiella pneumoniae (CR-KP) and carbapenem-resistant Escherichia coli (CR-ECO), the risks were 19.1% (21/110) and 13.8% (4/29), respectively. The independent risk factors for CR-KP clinical infection among CR-KP carriers were receiving mechanical ventilation (odds ratio (OR), 10.177; 95% confidence interval (CI), 2.667-38.830; =0.013), a high level of neonatal nutritional risk assessment (OR, 0.251; 95% CI, 0.072-0.881; =0.031) and a high neonatal acute physiology II (SNAP-II) score (OR, 0.256; 95% CI, 0.882-1.034; =0.025).
The colonization of CRE may increase the incidence of corresponding CRE infection in NICU patients. Receiving mechanical ventilation, malnutrition and critical conditions with high SNAP-II scores were independent risk factors for subsequent CR-KP clinical infection.
据报道，定植在耐碳青霉烯类肠杆菌科细菌（CRE）感染中起重要作用；然而，新生儿重症监护病房（NICU）患者中携带者发生临床CRE感染的程度及相关危险因素尚不清楚。
调查NICU患者中CRE定植的频率及其对感染的影响。
于2017年和2018年在NICU进行CRE定植筛查和CRE感染监测。
在1230例接受CRE定植筛查的NICU患者中，144例检测呈阳性（11.7%，144/1230），其中肠道定植率为9.2%（110/1197），高于上呼吸道定植率（6.6%，62/945）（P=0.026）。胎龄、低出生体重和住院时间延长是CRE定植的危险因素（均P<0.001）。Diversilab同源性监测发现，CRE定植患者的总体感染风险为17.4%（25/144）。对于耐碳青霉烯类肺炎克雷伯菌（CR-KP）和耐碳青霉烯类大肠埃希菌（CR-ECO），感染风险分别为19.1%（21/110）和13.8%（4/29）。CR-KP携带者中CR-KP临床感染的独立危险因素包括接受机械通气（比值比（OR），10.177；95%置信区间（CI），2.667-38.830；P=0.013）、新生儿营养风险评估水平高（OR，0.251；95%CI，0.072-0.881；P=0.031）和新生儿急性生理学II（SNAP-II）评分高（OR，0.256；95%CI，0.882-1.034；P=0.025）。
CRE定植可能增加NICU患者相应CRE感染的发生率。接受机械通气、营养不良和SNAP-II评分高的危急状况是随后CR-KP临床感染的独立危险因素。
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