新生儿重症监护病房器械相关感染流行病学多中心研究  

Multicenter study on epidemiology of device-associated infection in neonatal intensive care units

作　　者：任军红[1] 殷环[1] 吴安华[2] 胡必杰[3] 张秀月[4] 侯铁英[5] 宗志勇[6] 李卫光[7] 杨怀[8] 杨芸[9] 刘运喜[10] 文建国[11] 陆群[12] 贾会学[1] 李六亿[1] 

机构地区：[1]北京大学第一医院,北京100034 [2]中南大学湘雅医院,湖南长沙410008 [3]复旦大学附属中山医院,上海200032 [4]中国医科大学附属盛京医院,辽宁沈阳110004 [5]广东省人民医院,广东广州510008 [6]四川大学华西医院,四川成都610041 [7]山东省立医院,山东济南250021 [8]贵州省人民医院,贵州贵阳550002 [9]山西医学科学院山西大医院,山西太原030001 [10]解放军总医院,北京100853 [11]郑州大学第一附属医院,河南郑州450052 [12]浙江大学医学院附属第二医院,浙江杭州310009

出　　处：《中国感染控制杂志》2015年第8期530-534,共5页Chinese Journal of Infection Control

基　　金：中国医院协会医院感染预防与控制能力建设项目(CHA-2012-XSPX-0629-1)

摘　　要：目的 了解我国三级甲等综合医院新生儿监护病房（NICU）器械相关感染的流行特点,为预防和控制新生儿器械相关感染提供科学依据。方法 以多中心研究的方式,选取全国9个省及直辖市17所医院2013年10月—2014年9月NICU住院新生儿,按照统一的诊断标准和方法,对器械相关感染进行前瞻性监测。结果 共监测12 998例NICU住院新生儿,住院总日数为126 125 d,发生13例中央导管相关血流感染（CLABSI）、70例呼吸机相关肺炎（VAP）,中央静脉导管使用率为15.56%,CLABSI发病率为0.66‰;呼吸机使用率为7.67%,VAP发病率为7.23‰。≤1 000 g体重组中央静脉导管和呼吸机使用率最高,分别为61.06%和29.91%;床位数20-30张的NICU中央静脉导管使用率（16.67%）最高,呼吸机使用率（4.11%）最低;中央静脉导管和呼吸机使用率均以西南地区最高。不同规模NICU新生儿VAP发病率以床位数20-30张的NICU最低（2.36‰）。不同地区NICU新生儿CLABSI、VAP发病率比较,差异均有统计学意义;CLABSI和VAP发病率均以华南地区最高（分别为2.68‰、31.06‰）、西南地区次之。不同季度NICU新生儿CLABSI、VAP发病率比较,差异均无统计学意义（均P〉0.05）。结论 我国NICU器械使用率及其相关感染率较高,不同出生体重组、不同规模NICU、不同地区存在差异,应继续加强监测,根据感染特点落实防控措施。Objective To investigate the epidemiological characteristics of device-associated infection（DAI）in neonatal intensive care units（NICUs）of tertiary first-class hospitals in China,and provide scientific evidence for the prevention and control of neonatal DAI.Methods Neonates in NICUs at 17 hospitals of 9 provinces from October2013 to September 2014 were selected for multicenter study,DAI was surveyed prospectively according to the uniform diagnostic criteria and methods.Results A total of 12 998 neonates were monitored,the total patient-days were 126 125 d,13 cases of central line-associated bloodstream infection（CLABSI）and 70 cases of ventilator-associated pneumonia（VAP）occurred,central line utilization rate was 15.56%,incidence of CLABSI was 0.66/1 000device-days;ventilator utilization rate was 7.67%,incidence of VAP was 7.23/1 000 device-days.Utilization rates of central line and respirator in neonates with body weight≤1 000 g was the highest,which were 61.06% and29.91% respectively;In NICUs with20-30 beds,utilization rate of central line was the highest（16.67%）,and respirator was the lowest（4.11%）;of hospitals in different regions,central line and respirator utilization rate in southwest China was the highest.Of different sizes of ICUs,VAP per 1 000 device-days was the lowest in NICUs with20-30 beds（2.36 ‰）.Difference in incidence of CLABSI and VAP per 1 000 device-days in neonates at NICUs of different regions were significantly different;incidence of CLABSI and VAP per 1 000 device-days was highest in southern China（2.68 ‰ and 31.06‰ respectively）,followed by southwest region.Of different quarters,incidence of CLABSI,and VAP per 1 000 device-days were not significantly different（all P〉0.05）.Conclusion Device utilization rate and incidence of DAI in China are both high,and are different in neonates of different birth weight,at different sizes of NICUs,as well as different regions,monitoring should be intensified,prevention and control measures should be implemented

关 键 词：新生儿监护病房 中心静脉导管相关感染 呼吸机相关肺炎 流行病学 多中心研究 

分 类 号：R181.32[医药卫生—流行病学] R722[医药卫生—公共卫生与预防医学]