免疫功能低下和危重症儿科患者中耐碳青霉烯类革兰氏阴性菌定植：患病率、危险因素及结局
Carbapenem-Resistant Gram-Negative Bacteria Colonization in Immunocompromised and Critically Ill Pediatric Patients: Prevalence, Risk Factors, and Outcomes.
作者信息
Pimtimanon Naveeya, Assawawiroonhakarn Surapat, Boonsathorn Sophida
机构信息
Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
出版信息
Sage Open Pediatr. 2025 Aug 22;12:30502225251366351. doi: 10.1177/30502225251366351. eCollection 2025 Jan-Dec.
BACKGROUND
Carbapenem-resistant Gram-negative bacteria (CRGNB), including carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB) poses significant risks to immunocompromised and critically ill patients.
METHODS
A cross-sectional study was conducted at a tertiary care university hospital in Bangkok, Thailand (May 2023-October 2024). Hospitalized patients under 20 years of age who were immunocompromised or critically ill were enrolled. Rectal swabs were collected within 48 hours of admission.
RESULTS
Among 302 participants, 29 (9.6%) were colonized with CRGNB, including 19 (65.5%) with CRE and 10 (34.5%) with CRAB. Independent risk factors included recent surgery (adjusted OR 7.6, = .006), hospital referral (aOR 3.03, = .043), and younger age (aOR 0.86, = .02). Colonized patients had longer hospital stays (median 12 days vs 6 days, = .001) and higher mortality (17.2% vs 5.5%, = .022).
CONCLUSION
CRGNB colonization was identified in nearly 10% of high-risk pediatric patients and associated with unfavorable outcomes. Early identification and targeted infection control are essential.
背景
耐碳青霉烯类革兰氏阴性菌（CRGNB），包括耐碳青霉烯类肠杆菌科细菌（CRE）和鲍曼不动杆菌（CRAB），对免疫功能低下和重症患者构成重大风险。
方法
在泰国曼谷的一家三级护理大学医院进行了一项横断面研究（2023年5月至2024年10月）。纳入20岁以下免疫功能低下或重症的住院患者。在入院后48小时内采集直肠拭子。
结果
在302名参与者中，29名（9.6%）被CRGNB定植，其中19名（65.5%）为CRE定植，10名（34.5%）为CRAB定植。独立危险因素包括近期手术（调整后的比值比为7.6，P = 0.006）、医院转诊（调整后的比值比为3.03，P = 0.043）和年龄较小（调整后的比值比为0.86，P = 0.02）。定植患者的住院时间更长（中位数为12天对6天，P = 0.001），死亡率更高（17.2%对5.5%，P = 0.022）。
结论
在近10%的高危儿科患者中发现了CRGNB定植，且与不良结局相关。早期识别和针对性的感染控制至关重要。
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