新生儿重症监护病房多重耐药菌感染的病原学调查及风险预测方案探讨

doi:10.3760/cma.j.cn441417-20250208-11017

摘要/Abstract

摘要：

目的　调查新生儿重症监护病房（NICU）多重耐药菌（MDRO）感染的病原学特征，并探讨NICU新生儿MDRO感染的风险预测方案。方法　回顾性分析2020年3月至2024年9月咸阳市第一人民医院NICU收治的387例感染新生儿临床资料，分析MDRO感染的病原学情况，并按照2∶1比例将其分为建模组（258例）和验证组（129例）。建模组男156例、女102例，出生胎龄<37周65例、≥37周193例；验证组男82例、女47例，出生胎龄<37周36例、≥37周93例。根据MDRO感染情况将建模组分为MDRO感染组（83例）和非MDRO感染组（175例）。分析NICU新生儿MDRO感染的影响因素，并基于此构建风险预测列线图模型。采用Bootstrap法对列线图模型进行验证，并绘制校准曲线、受试者操作特征曲线（ROC）评价列线图模型的校准度及预测效能，绘制决策曲线验证模型的临床净获益率。采用χ2检验、t检验进行统计分析。结果　NICU新生儿MDRO感染率为32.56%（126/387），126例MDRO感染新生儿共检出MDRO菌株187株，其中革兰阴性菌占68.45%（128/187），革兰阳性菌占31.55%（59/187）。大肠埃希菌、肺炎克雷伯菌均对头孢曲松耐药率最高，分别为77.14%、82.35%；对美罗培南耐药率最低，均为0。金黄色葡萄球菌、溶血葡萄球菌均对青霉素耐药率最高，分别为100.00%、95.00%；对万古霉素耐药率最低，均为0。建模组与验证组临床资料差异均无统计学意义（均P>0.05）。产前1周内母亲使用抗生素、出生胎龄<37周、出生体质量<2 500 g、低蛋白血症、有创机械通气、使用抗菌药物种类≥3种、使用抗菌药物时间≥7 d均是NICU新生儿MDRO感染的危险因素（均P<0.05）。基于上述影响因素构建列线图模型，列线图模型在建模组和验证组中预测的一致性指数分别为0.853、0.841，校准曲线和理想曲线拟合度均较好。ROC结果显示，建模组、验证组预测NICU新生儿MDRO感染的曲线下面积分别为0.893（95%置信区间0.851～0.947）、0.865（95%置信区间0.795～0.936）。决策曲线显示，建模组风险阈值概率在0.4%～70.0%、85.0%～100.0%时和验证组在0.4%～52.0%、56.0%～73.0%、84.0%～100.0%时有较高的净获益值。结论　NICU新生儿MDRO感染的主要病原菌为大肠埃希菌和金黄色葡萄球菌，产前1周内母亲使用抗生素、出生胎龄、出生体质量、低蛋白血症、有创机械通气、使用抗菌药物种类、使用抗菌药物时间均为影响NICU新生儿MDRO感染的风险因素，基于以上影响因素构建的列线图模型具有良好的校准度和预测效能，临床应用价值高。

关键词: 感染 , 多重耐药菌 , 新生儿重症监护病房 , 病原学 , 影响因素 , 列线图 , 新生儿

Abstract:

Objective　To investigate the microbiological characteristics of multidrug-resistant organism (MDRO) infections in the Neonatal Intensive Care Unit (NICU) and to explore a risk prediction scheme for MDRO infections in NICU neonates. Methods　A retrospective analysis was conducted on the clinical data of 387 neonates with infections admitted to the NICU of Xianyang First People's Hospital from March 2020 to September 2024. The microbiological status of MDRO infections was analyzed, and the cases were divided into a modeling group (258 cases) and a validation group (129 cases) in a 2:1 ratio. The modeling group included 156 males and 102 females, with 65 cases born at a gestational age of <37 weeks and 193 cases born at ≥37 weeks; the validation group included 82 males and 47 females, with 36 cases born at <37 weeks and 93 cases born at ≥37 weeks. The modeling group was further divided into an MDRO infection group (83 cases) and a non-MDRO infection group (175 cases). Factors influencing MDRO infections in NICU neonates were analyzed, and a nomogram risk prediction model was constructed based on these factors. The model was validated using the Bootstrap method, and calibration curves and receiver operating characteristic (ROC) curves were plotted to evaluate the model's calibration and predictive performance, along with decision curves to assess the clinical net benefit of the model. Statistical analysis was performed using χ² tests and t tests. Results　The MDRO infection rate in NICU newborns was 32.56% (126/387). A total of 187 MDRO strains were detected in 126 newborns with MDRO infection, of which Gram-negative bacteria accounted for 68.45% (128/187), Gram-positive bacteria accounted for 31.55% (59/187). The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were the highest, which were 77.14% and 82.35%, respectively, and the resistance rate to meropenem was the lowest, which was 0.00%. The resistance rates of Staphylococcus aureus and Staphylococcus haemolyticus to penicillin were the highest, which were 100.00% and 95.00%, respectively, and the resistance rate to vancomycin was the lowest, which was 0.00%. There was no statistically significant difference in clinical data between the modeling group and the verification group (all P>0.05). Risk factors for MDRO infections in NICU neonates included maternal antibiotic use within one week prior to delivery, gestational age <37 weeks, birth weight <2,500 g, hypoalbuminemia, invasive mechanical ventilation, use of three or more types of antimicrobial agents, and duration of antimicrobial use ≥7 days (all P<0.05). Based on the above influencing factors, the nomogram model was constructed. The consistency index of the nomogram model in the modeling group and the verification group was 0.853 and 0.841, respectively, with good fit between the calibration curves and the ideal curve. ROC analysis revealed area under the curve (AUC) values for predicting MDRO infections in NICU neonates of 0.893 (95% confidence interval 0.851-0.947) for the modeling group and 0.865 (95% confidence interval 0.795-0.936) for the validation group. Decision curve analysis indicated that the risk threshold probabilities for the modeling group were 0.4%-70.0% and 85.0%-100.0%, while for the validation group, they were 0.4%-52.0%, 56.0%-73.0%, and 84.0%-100.0%, all showing high net benefit values. Conclusion　The main pathogens of MDRO infections in NICU neonates are Escherichia coli and Staphylococcus aureus. Factors influencing MDRO infections in NICU neonates include maternal antibiotic use within one week prior to delivery, gestational age, birth weight, hypoalbuminemia, invasive mechanical ventilation, types of antimicrobial agents used, and duration of antimicrobial use. The nomogram model constructed based on these factors demonstrates good calibration and predictive performance, indicating high clinical application value.

Key words: Infection, , Mlti-drug resistant bacteria, , Neonatal intensive care unit, , Etiology, , Influencing factors, , Nomogram, , Neonates

张苏红任红娟王卫华李婷吕菊迎. 新生儿重症监护病房多重耐药菌感染的病原学调查及风险预测方案探讨 [J]. 国际医药卫生导报, 2025, 31(11): 1850-1858.

Zhang Suhong, Ren Hongjuan, Wang Weihua, Li Ting, Lyu Juying.

Etiological investigation and risk prediction of multidrug resistant organism infection in NICU neonates [J]. International Medicine and Health Guidance News, 2025, 31(11): 1850-1858.

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