Distribution,Migration And Risk Factors Of Multidrug-resistant Organisms In Neonatal And Pediatric Wards

[Objective]To analyze the distribution and migration of multidrug-resistant organisms in neonatal intensive care unit(NICU),general neonatal ward and pediatric ward,and to explore the risk factors of multidrug-resistant organisms,so as to provide clinical basis for the prevention and treatment of multidrug-resistant organisms infection in children.[Methods]A retrospective study was conducted based on medical records of patients with MDROs in the neonatal and pediatric wards of Shenzhen Maternity and Child Healthcare Hospital,from January 2017 to May 2020.According to the "Multidrugresistant(MDR),extensively drug-resistant(XDR)and pandrug-resistant(PDR)bacteria: an international expert proposal for interim standard definitions for acquired resistance",the cases with multidrug-resistant organisms were selected from neonatal intensive care unit,neonatal general ward and pediatric ward as study group(including 151 cases in NICU,74 cases in neonatal general ward and 129 cases in pediatric ward);In the same period,the control group included 272 cases of NICU,109 cases of neonatal general ward and 130 cases of pediatric ward.The distribution and migration of multidrug-resistant organisms were statistically analyzed.The differences of gender,age,gestational age,birth weight,maternal risk factors,invasive operation and other indicators between children with and without multidrug-resistant organisms in NICU,neonatal general ward and pediatric ward were compared,and the related risk factors of multidrug-resistant organisms were discussed.The data were processed by SPSS 21.0 software package.Chi-square(χ~2)test was performed to compare count data(expressed as rate data)between different groups.Under the normality assumption,Student’s t-test was conducted to compare the measurement data(expressed as mean ± standard deviation)between different groups;if the measurement variables were not normally distributed,non-parametric test(Mann-Whitney U test)was performed.P-value less than 0.05ng/ml was considered statistically significant.[Results]The detection of multidrug-resistant organisms: 1.In NICU,the main multidrug-resistant organisms were Escherichia coli and Staphylococcus(56.82%,29.55%);in addition,Klebsiella pneumoniae accounted for 9.0% of all multidrug-resistant organisms in NICU.Overall,the proportion of Gram-negative MDROs in NICU was greater than that of Gram-positive MDROs(67.73% vs32.27%).From 2017 to 2019,Escherichia coli was the most common and widespread multidrug-resistant organism in NICU.2.In general neonatal ward,the main multidrug-resistant organisms were Escherichia coli and Staphylococcus(53.95%,31.58%).Overall,the proportion of Gram-negative MDROs was greater than that of Gram-positive MDROs(57.89% vs 42.11%),and the type and proportion of MDROs were similar to NICU.From 2017 to 2020,Escherichia coli was the most common and widespread multidrug-resistant organism in general neonatal ward.3.In pediatric ward,Salmonella and Escherichia coli were the main MDROs(38.46%,30%).Overall,the proportion of Gram-negative MDROs was greater than that of Gram-positive MDROs(75.38% vs 24.62%).Risk factor analysis: 1.The risk factor analysis of NICU showed that taking antibiotics by the mothers during a week before delivery,children with hypoalbuminemia,lumbar puncture,PICC and LYM percentages were statistically correlated with the occurrence of MDROs in NICU.2.In general neonatal ward,the use of antibiotics in neonates reduced the risk of detection of MDROs.3.Absolute neutrophil count and PCT value were correlated with MDROs in pediatric ward.Children with a PCT of 0.5-2ng/ml and ≥10ng/ml have an increased risk of detection of MDROs.The occurrence of MDROs decreased by 7.4% with the escalation of absolute neutrophil count by one unit.[Conclusion]Escherichia coli was the most common multidrug-resistant organism in NICU and general neonatal ward,and the distribution of MDROs was similar.Salmonella was the most common multidrug-resistant organism in pediatric ward and Escherichia coli was in the second.Taking antibiotics by the mothers during a week before delivery and children with hypoalbuminemia were the risk factors for the detection of MDROs in NICU.The risk factors for the detection of MDROs in pediatric ward were PCT value of 0.5-2ng/ml and ≥10ng/ml.