新生儿重症监护病房早产儿医院感染临床分析  

Clinical analysis of nosocomical infection of premature infants in NICU

作　　者：陈历耋[1] 傅万海[1] 游楚明[1] 覃晓菲[1] 赵有为[1] 

机构地区：[1]南华大学教学医院广东省第二人民医院儿科,广州510000

出　　处：《中国新生儿科杂志》2013年第2期80-84,共5页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿重症监护病房(NICU)早产儿医院感染的危险因素和抗生素使用状况,以对早产儿医院感染防控提供依据。方法回顾性分析2009-2011年我院NICU收治的早产儿临床资料,对医院感染发生率、感染的临床特点、危险因素等进行分析。结果 699例早产儿中,144例发生198次医院感染,医院感染发生率20.6%,住院日相关的医院感染发生率为17.5例次/1000住院日;呼吸机相关性肺炎(VAP)发生率74.3例次/1000机械通气日,中心静脉置管相关败血症(CRBSI)发生率2.2例次/1000导管日。发生感染日龄(16.5±12.8)天,发生医院感染的早产儿比未感染者使用抗生素级别更高,住院时间更长,肺部感染占首位,共91例。单因素分析显示,早产儿医院感染的危险因素为男婴、胎龄<32周、体重<1500g、胃肠外营养、机械通气及中心静脉置管时间长(P<0.05),进一步logistic回归分析提示,胎龄<32周(OR=4.21,95%CI1.924～10.915)、胃肠外营养(OR=6.18,95%CI3.187～13.734)、机械通气时间长(OR=6.72,95%CI4.057～11.134)是NICU早产儿医院感染的独立危险因素。结论早产儿是医院感染的高发群体,胎龄<32周、胃肠外营养及机械通气是早产儿医院感染的危险因素。Objective To investigate risk factors and clinical data of antibiotic usages related to nosocomial infection in premature infants in NICU. Methods Retrospective study of the rate, risk factors and clinical characteristics of nosocomial infection in 699 neonates were conducted. Results Total of 144 premature neonates （20. 6% ） have developed 198 times of infections during hospital stay. This represents an incidence of 17.5 cases per 1000 patient hospitalization days; ventilator-associated pneumonia （VAP） incidence of 74.3 cases per 1000 mechanical ventilation days; central venous catheter-related sepsis （CRBSI） incidence of 2.2 cases per 1000 central venous catheter days. The average onset of infection was at 16.5 ± 12. 8 days of hospitalization. Infants with nosocomial infections also had longer hospital stays. Single-factor analysis revealed that prematurity, male gender, gestational age 〈 32 weeks, weight 〈 1500 g, parenteral nutrition, mechanical ventilation and central venous catheter placement were risk factors for nosocomial infection in preterm neonates （ P 〈 0. 05 ）. Logistic analysis revealed that gestational age 〈 32 weeks （ OR = 4.21,95% CI 1. 924 - 10. 915, P = 0. 007）, parenteral nutrition （ OR = 6. 18,95% CI 3. 187 - 13.734, P 〈0. 001 ）, and mechanical ventilation （ OR = 6.72,95% CI 4. 057 - 11. 134, P 〈 0. 001 ） were independent predictors of nosocomial infectionin premature infants. Conclusions Younger than 32 weeks gestational age, parenteral nutrition and mechanical ventilation are the significant risk factors for preterm neonatal nosocomial infections in NICU. Therefore, minimizing the duration for parenteral nutrition and mechanical ventilation, emphasizing aseptic and hand washing techniques would likely decrease the incidence for nosocomial infection.

关 键 词：医院感染 危险因素 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]