Abstract:

Objective　To explore the pathogen characteristics and risk factors of nosocomial infection in children with refractory pneumonia caused by Mycoplasma pneumoniae. Methods　A total of 160 children［nosocomial infection（45 cases） as observation group，no nosocomial infection（115 cases） as control group］ with refractory MPP who were admitted from January 2015 to January 2018 were selected for pathogen detection and pathogen species analysis. Analyze the differences of two groups to detect the risk factors of hospital infection by means of univariate and multivariate logistic analysis. Results　According to the analysis of the pathogens，32 of them were bacterial infections（71.1%），and Gram-negative bacteria were the main pathogens，including Haemophilus influenza（9 cases），Klebsiella pneumonia（7 cases），Escherichia coli （5 cases） and Legionella pneumophila（2 cases）；13 of them were viral infections（28.9%），including influenza B virus（6 cases），respiratory syncytial virus（5 cases）and adenovirus（2 cases）. After univariate and multivariate logistic analysis，no differences were found in sex，age，congenital heart disease or anemia between observation group and control group（P＞0.05）. However，the length of hospitalization，season of onset，invasive procedures，non-single ward，and the irrational use of antibiotics in the two groups had significant differences（P＜0.05）. Conclusion　The main infection pathogen of children with refractory MMP in nosocomial infection is Gram-negative bacteria. The risk factors of nosocomial infection are the length of hospitalization， season of onset，invasive procedures，non-single ward，and the irrational use of antibiotics.

Key words: refractory Mycoplasma pneumoniae pneumonia, nosocomial infection, risk factors, pathogen

摘要：

目的　探讨儿童难治性肺炎支原体肺炎（MPP）发生医院感染的病原体特点及危险因素。方法　回顾性分析2015年1月至2018年1月东南大学医学院附属南京同仁医院收治的160例难治性MPP患儿的临床资料。其中45例医院感染患儿为观察组， 115例非院内感染患儿为对照组。对发生医院感染患儿进行病原体检测并分析其病原体种类。使用单因素及多因素Logistic分析方法分析引起医院感染的危险因素。结果　对发生医院感染的难治性MPP患儿进行病原体分析发现，细菌感染为32例， 占感染总数的71.1%， 主要为革兰氏阴性菌， 其中流感嗜血杆菌9例、 肺炎克雷伯杆菌7例、 大肠埃希菌5例、 嗜肺军团菌2例； 病毒感染为13例， 占感染总数的28.9%， 其中乙型流感病毒6例、 呼吸道合胞病毒5例、 腺病毒2例。Logistic分析发现观察组性别、 年龄、 先天性心脏病、 贫血与对照组比较， 差异无统计学意义（P＞0.05）； 但住院时间、 发病季节、 侵入性操作、 非单人间病房、 抗生素的不合理使用与对照组比较，差异有统计学意义（P＜0.05）。结论　儿童难治性MPP发生医院感染的病原体主要为革兰氏阴性菌， 其中医院感染的危险因素与住院时间、 发病季节、 非单人间病房、 侵入性操作以及抗生素不合理使用有关。

关键词: 难治性肺炎支原体肺炎, 医院感染, 危险因素, 病原体