Risk Factors,drug Resistance Analysis And Coping Strategies Of Multiple Drug-resistant Bacteria Infection In Pediatric Intensive Care Unit

Objective: In order to understand the current situation of multi-drug resistant bacteria infection in pediatric icu and to provide reliable basis for the prevention and treatment of nosocomial infections.We retrospectively analyzed the clinical characteristics,risk factors and drug resistance of children with multidrug-resistant bacteria in pediatric icu of Qingdao University Hospital.Methods: In January 2017-December 2019 all patients with infectious diseases shall be carried out in accordance with the characteristics of infection ward corresponding etiology examination,the results show that for the case of multi-resistant bacteria cases for data collection,sorting and record multiple drug-resistant bacteria source,composition and number of resistant strains to all kinds of antibiotics,ni,and analysis of the clinical characteristics of patients.Results:A total of 92 strains of multi-drug resistant bacteria were isolated from 61 patients.Among the 61 patients,43 were male,18 were female,57 were cured and 4 died.Among the61 patients,43 were male,18 were female,57 were cured and 4 died.The median age of the patients was 19 months,including 27 cases of infants aged 28 days to 1 year old,18 cases of infants aged 1-3 years old,5 cases of children aged 3-6 years old,and 11 cases of children over 6 years old.The median length of hospital stay was 27 days,with 36 cases over 20 days.There were 14 cases of multidrug-resistant bacteria infection caused by chemotherapy for leukemia,25 cases of ventilator-associated pneumonia caused by multidrug-resistant bacteria infection after endotracheal intubation and mechanical ventilation,and 39 cases of patients diagnosed with parenteral nutrition caused by multidrug-resistant bacteria.All the patients had 1-3 antibiotic use before admission or transfer to pediatric icu,and 48 patients had 2 or more antibiotics.According to logistic regression analysis,the hospitalization days ?20d,leukemia,endotracheal intubation,parenteral nutrition,and the use of more than two antibiotics before admission or transfer to pediatric intensive care unit were the risk factors for infection with multidrug-resistant bacteria.Among them,venous blood samples were from 39 strains,followed by sputum and alveolar lavage fluid,various end of catheter,ascites and abdominal drainage fluid,midstream urine,cerebrospinal fluid and stool.There were 51 strains of 92 strains of multidrug-resistant strains of gram-negative bacteria,and 24 strains of Klebsiella pneumoniae produced the most-lactamase,followed by Acinetobacter baumannii,Pseudomonas aeruginosa and Escherichia coli produced the most-lactamase.There were 41 strains of gram-positive bacteria,of which methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis were the most,16 strains each,followed by human Staphylococcus,and enterococcus that was not resistant to vancomycin was not found.All gram-negative multidrug-resistant bacteria were resistant to quinolones and aminoglycosides antibiotics at a rate of more than 70%.In addition to the production of ultra broad spectrum-lactamase Escherichia coli,the resistance rate of the other gram-negative bacteria to the hydrocarbon enes antibiotic was above 65%,among which acinetobacter baumannii was up to 100%.Three strains of Klebsiella pneumoniae,one strain of Acinetobacter baumannii and four strains of Pseudomonas aeruginosa were resistant to tiagocycline,respectively.The resistance rate of gram-positive bacteria to benzoxicillin,penicillin G,erythromycin and clindamycin was above 80%,and no gram-positive resistant strains to vancomycin and linezolid were found.Conclusion:In the department of Pediatric intensive Care Medicine of The Affiliated Hospital of Qingdao University,multidrug-resistant bacterial infection was more common in infants under 1 year old,followed by infants between 1 and 3 years old,and male patients were more than female.Hospitalization days ? 20 d,leukaemia,endotracheal intubation,parenteral nutrition,and the use of more than two antibiotics before admission or transfer to pediatric intensive care unit were high risk factors for infection with multidrug-resistant bacteria,and were also common causes of nosocomial infections The monitoring of drug-resistant bacteria should be strengthened and unreasonable drug use should be eliminated in clinical practice.Therefore,it is necessary to strengthen nursing care for children with high risk factors of infection and rationally formulate anti-infection treatment strategies to prevent the infection of multi-drug-resistant bacteria.Gram-positive multidrug-resistant bacteria were methicillin-resistant Staphylococcus and Epidermococcus,and were significantly resistant to penicillin,erythromycin and clindamycin.Klebsiella pneumoniae was the most common gram-negative multidrug-resistant bacteria,and was resistant to most antibiotics.Etiological examination and drug sensitivity test are still the main basis to guide rational selection of antibiotics in clinic.