Characteristics and risk factors of multidrug-resistant organisms infection in neonatal intensive care unit

Objective To analyze the characteristics of multidrug-resistant organisms （MDROs） in neonatal intensive care unit （NICU）, and to determine the risk factors of MDROs infection, aiming to provide clinical basis for reducing the risk of MDROs infection. Methods Medical record of children infected with MDROs were retrospectively analyzed. According to the "Multidrug-resistant （MDR）, extensively drug-resistant （XDR） and pandrug-resistant （PDR） bacteria： an international expert proposal for interim standard definitions for acquired resistance", 220 strains were isolated from 151 children with MDROs infection in NICU, and 272 counterparts without MDROs infection in NICU were enrolled as controls. The distribution characteristics of MDROs were analyzed. The risk factors related to the infection of MDROs were identified by univariate and multivariate Logistic regression analyses. Results Escherichia coli was the most common and widespread MDROs in different years, followed by Staphylococcus. Maternal intake of antibiotics within 1 week before delivery, peripherally inserted central venous catheters （PICC）, lumbar puncture, children with hypoproteinemia and lymphocyte ratio were significantly correlated with the infection of MDROs in NICU （all P < 0.05）. The risk of MDROs infection in mothers who took antibiotics within 1 week before delivery was significantly higher compared with that in those without use of antibiotics within 1 week before delivery （OR = 2.268, 95%CI 1.095-4.700）. Compared with patients without hypoproteinemia, the risk of MDROs infection in patients with hypoproteinemia was remarkably elevated （OR = 4.999, 95%CI 2.849-8.700）. The risk of MDROs infection in patients receiving lumbar puncture was significantly lower than that in their counterparts without lumbar puncture （OR = 0.368, 95%CI 0.184-0.737）. Compared with patients without PICC, the risk of MDROs infection in patients undergoing PICC was considerably decreased （OR = 0.473, 95%CI 0.266-0.842）. The risk of MDROs infection was reduced by 1.7% when the lymphocyte ratio was increased by 1% （OR = 0.983, 95%CI 0.969-0.997）. Conclusion Escherichia coli is the most common MDRO in NICU. Maternal intake of antibiotics within 1 week before delivery and children with hypoproteinemia are the risk factors for the infection of MDROs in NICU.