NICU导管相关感染现状调查分析  

Investigation of device-associated nosocomial infection in neonatal intensive care unit

作　　者：陈敏[1,2] 李晓瑜[1] 庄思齐[1] 谢巧庆[1] 余慕雪[1] 刘美娜[1] 黄越芳[1] 

机构地区：[1]中山大学附属第一医院儿科,广东广州510080 [2]广东省广州市儿童医院

出　　处：《临床儿科杂志》2009年第3期222-225,共4页Journal of Clinical Pediatrics

摘　　要：目的调查分析新生儿重症监护病房医疗装置导管相关感染的发生率、危险因素及病原菌的分布特点。方法收集2002年1月-2007年12月248例入住中山大学附属第一医院NICU,并接受气管插管及经外周置入中心静脉导管患儿的临床资料,分析导管装置相关感染发生的百分率和导管相关感染的感染率、病原菌种类和特点。结果248例患儿中,侵入性操作相关感染141例次(56.9%);发生呼吸机相关肺炎感染率为66.9%或64.9/1000通气日,导管相关血源感染为7.7%或5.8/1000置管日。置管时间和多种侵入性操作是导管相关感染的独立危险因素。导管相关感染的病原菌以耐甲氧西林凝固酶阴性葡萄球菌为主(占29.4%),其次分别为肺炎克雷伯杆菌(14.7%,ESBL为主)、铜绿假单胞菌(8.6%)、金黄色葡萄球菌(8.0%)、阴沟肠杆菌(8.0%)。结论NICU导管相关感染尤其是呼吸机相关肺炎的感染率高,病原菌多为耐药菌,需采取有效的干预措施进一步降低院内感染的发生率。Objective To investigate the incidence of device-associated infection, the associated risk factors and the pathogenic distribution of nosocomial infection in the neonatal intensive care unit （NICU） of a level Ⅲ hospital. Methods Clinical data were collected in 248 infants （228 of them were preterm infants） admitted to NICU during Jan, 2002 to Dec, 2007. All infants had undergone endotracheal incubation for mechanical-assisted ventilation and/or peripherally inserted central catherization （PICC） . Results The incidence of device-associated infection was 56% （141/248 cases）. The rates of the intervention-associated infection were 66.9% for ventilator-associated pneumonia or 64.9/1 000 ventilator-days, 7.7% for PICC-related bloodstream infection or 5.8/1000 central line-days, respectively. Logistic regression analysis showed that the time of ventilation and the several invasive therapeutic interventions were the independent risk factors for device-associated infection. The most common nosocomial pathogens were methicillin-resistant coagulase-negative staphylococci （29.4%）, Klehsiella pneumonia bacilli （ 14.7%, predominantly ESBLs）, Pseudomonas aeruginosa （8.6%）, Methicillin- resistant Staphylococcus aureus （8.0%） and Enterobacter cloacae （8.0%）. Conclusions The rate of device-associated infection, in particular ventilator-associated infection in NICU, is very high. The antimicrobial-resistant pathogens are commonly seen in nosocomial infections. It is suggested that active infection control programs should be taken to decrease the incidence of nosocomial infection.

关 键 词：重症监护病房 新生儿 导管相关感染 

分 类 号：R720.597[医药卫生—急诊医学]