Analysis of factors influencing antibacterial efficacy in children with severe pneumonia infected by MDRO
Jiang Xunnan , Zhu Xiaoping, Ouyang Jie, et al
1. Guizhou Medical University, Guizhou, Guiyang 550000, China; 2. Department of Pediatrics, Anshun City People's Hospital, Guizhou, Anshun 561000, China)
Abstract: 【 Abstract 】 Objective To investigate the influencing factors of antibacterial efficacy in children with severe pneumonia infected by multidrug-resistant organism (MDRO). Methods The clinical data of 75children with severe pneumonia infected by MDRO admitted to Anshun City People's Hospital from January2020 to October 2022 were retrospectively analyzed. The characteristics of MDRO pathogens and the drug resistance of main pathogens were recorded, and sensitive antibiotics were selected for treatment. According to the antibacterial e?cacy, the children were divided into e?ective group (n=19) and ine?ective group (n=56). The general data and laboratory indicators [white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP) and neutrophil count] of the two groups were collected. Multivariate Logistic regression analysis was used to identify the factors in?uencing the antibacterial e?cacy in children. The predictive performance and clinical utility of laboratory indicators were evaluated by the receiver operating characteristic (ROC) curve and decision curve. Statistical analysis was performed using t-test, χ2 test. Results A total of 80 MDRO strains were cultured in 75 children, including 12 strains of fungi (15.00%), 50 strains of Gram-negative bacteria (62.50 %), and 18 strains of Gram-positive bacteria (22.50%). The main drug-resistant bacteria showed that Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were completely resistant to Ampicillin and Cefotaxime, and highly resistant to Ceftriaxone, Piperacillin/Tazobactam and Cefoperazone-Sulbactam. Staphylococcus epidermidis and Staphylococcus aureus were fully resistant to Vancomycin and Erythromycin. The proportion of previous antibiotic use, invasive mechanical ventilation, the length of stay in the pediatric intensive care unit (PICU) ≥7 d, and parenteral nutrition in the ine?ective group were higher than those in the e?ective group [47.37% (9/19) vs 23.21% (13/56), 31.58% (6/19) vs 8.93% (5/56), 89.47% (17/19) vs 10.71% (6/56), 31.58% (6/19) vs 8.93% (5/56), χ2 values were 3.993, 4.146, 37.767, 4.146, respectively; all P<0.05]. The levels of PCT, WBC, neutrophil count, and CRP in the ine?ective group were higher than those in the e?ective group [(15.56±4.66) μg/L vs (10.81 ±3.24) μg/L, (12.26 ± 3.60) × 109/L vs (8.55 ±2.57) × 109/L, (4.45 ± 1.30) × 109/L vs (3.11 ±0.93) × 109/L, (72.72±20.82) μg/L vs (51.98 ± 15.60) μg/L, respectively; t values were 4.912, 4.888, 4.883, 4.585, respectively; all P<0.05 ］After adjustment, multivariate Logistic regression analysis showed that the levels of serum PCT, WBC, neutrophil count, and CRP were the high-risk factors for antibacterial failure in children with severe pneumonia infected by MDRO (P<0.05). Conclusion The main pathogens in children with severe pneumonia infected by MDRO are Gram-negative bacteria, with Staphylococcus epidermidis and Staphylococcus aureus exhibiting high resistance to Vancomycin and Erythromycin. Furthermore, the levels of serum PCT, WBC, neutrophil count, and CRP demonstrate considerable predictive value and clinical applicability in evaluating the antibacterial e?cacy for severe pneumonia infected by MDRO.
2026, Vol. 14 
