220例极低出生体质量儿医院感染的临床分析  

Clinical analysis of nosocomial infection among 220 infants with very low birth weight

作　　者：刘前芳[1,2] 陈新红[1] 张先红[1] 华子瑜[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿科,重庆400014 [2]德阳市人民医院儿科,四川德阳618000

出　　处：《第三军医大学学报》2013年第5期451-455,共5页Journal of Third Military Medical University

基　　金：2011年度国家临床重点专科建设项目[卫办医政函2011(873号)]~~

摘　　要：目的探讨极低出生体质量儿(very low birth weight infants,VLBWIs)医院感染的临床特点及危险因素,为其防治提供依据。方法对我院新生儿重症监护室(NICU)2010年1月至2011年12月收治的住院时间>48 h的220例VLBWIs临床资料进行回顾性分析。结果院感组88例发生医院感染125例次,医院感染率40.0%,与住院时间相关的医院感染率19.5‰。医院感染主要包括呼吸道感染(66.4%),消化道感染(15.2%)和败血症(12.0%)。97株G-菌对青霉素类、头孢菌素类抗生素耐药率88.3%～97.9%,喹诺酮类、碳青霉烯类抗生素耐药率<30%。院感组、非院感组抗生素使用强度分别为3.76,2.32;人均抗生素消耗量(1.67±1.21)g/DDD值规定日剂量(defined daily dose,DDD),(0.62±0.50)g/DDD值,差异有统计学意义(P<0.01)。院感组住院时间(44.38±25.98)d较非院感组(19.05±15.29)d长(P<0.01)。Logistic回归表明:住院时间>28 d、机械通气时间>72 h和脂肪乳使用>14 d是VLBWIs医院感染的独立危险因素。结论 VLBWIs医院感染率高,使住院时间延长,抗生素使用强度和消耗量增加。缩短机械通气、脂肪乳使用和住院时间,可能使VLBWIs医院感染减少。Objective To investigate the clinical characteristics and risk factors of nosocomial infection （NI） in very low birth weight infants （VLBWIs）. Methods Clinical data of 220 VLBWIs admitted to our NICU and hospitalized over 48 h from Jan 2010 to Dec 2011 were analyzed retrospectively. Results There were 88 cases in the NI group suffered from 125 NIs. The incidence of NI was 40.0% and hospital stay-related incidence was 19.5%. Among the 125 NIs, there were 83 （66.4%） respiratory tract infections, 19 （15.2%） digestive tract infections and 15 （12.0%） septicemia. There were 97 strains of G- bacteria, of which resistance rate to penicillins and cephalosporins was 88.3% to 97.9%, whereas less than 30% to quinolones and carbapenems. Antibiotic use intensity was 3.76 in the NI group and 2.32 in the non-NI group. Antibiotic consumption was （1.67±1.21） g/DDD （defined daily dose, DDD） for each VLBWIs in the NI group, which was significantly different from that in the non-NI group [（0.62 0.50）g/DDD] （P〈0.01）. The duration of hospital stay in the NI group [（44.38±25.98） d] was longer than that of the non-NI group [（19.05±15.29） d] （P〈0.01）. Logistic regression analysis showed the independent risk factors of NI included hospital stay over 28 d, mechanical ventilation over 72 h and lipid emulsion infusion over 14 d. Conclusion NI incidence in VLBWIs is high. It prolongs hospital stay, and increases antibiotic use intensity and consumption. For effective control of NI in VLBWIs, it is critical to shorten the time of hospital stay, mechanical ventilation and lipid emulsion infusion.

关 键 词：极低出生体质量儿 医院感染 危险因素 

分 类 号：R181.31[医药卫生—流行病学] R639[医药卫生—公共卫生与预防医学]