新生儿皮肤黏膜凝固酶阴性葡萄球菌定植高危因素分析  

High risk factors of coagulase-negative Staphylococci colonization on skin and mucous in neonates

作　　者：焦颖[1] 张巍[1] 刘巍巍[1] 邢继伟[1] 

机构地区：[1]首都医科大学附属北京妇产医院新生儿重症监护室,北京100026

出　　处：《中国妇幼健康研究》2017年第8期900-901,934,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨新生儿凝固酶阴性葡萄球菌(CNS)的定植特点及高危因素。方法对2015年8月至2016年5月在北京妇产医院新生儿重症监护室(NICU)B病区住院的新生儿进行鼻部、眼部、脐带、直肠拭子培养,每周1次;静脉导管移除后管端培养。获取每一个CNS定植新生儿临床资料,同期培养阴性的新生儿作为对照组,采用多元线性回归方法进行高危因素分析。结果在712名入住NICU的新生儿中,60例(8.4%)新生儿发现CNS定植,中位数天数为8天(四分位差4~13),最常见的CNS定植部位为鼻咽部(n=24),其次是气管插管(n=12)。CNS定植单因素分析显示实验组的出生体重及胎龄明显低于对照组(t值分别为-17.501、-11.518,均P<0.05),实验组小儿导管使用率明显高于对照组(χ~2值分别为34.751、28.229、14.101、62.484,均P<0.05),但两组性别、子宫下段剖宫产、入院年龄、脐炎的发生情况比较均无统计学意义(均P>0.05)。多元线性回归分析显示孕周(P=0.042)、出生体重(P=0.000)、经皮插入的中心导管(CVC)(P=0.006)、口鼻吸引(P=0.011)、呼吸机辅助呼吸(P=0.050)、全肠外营养(P=0.015)是CNS定植的独立高危因素。结论早产、低出生体重、呼吸机使用、中心静脉置管是CNS定植的高危因素,而频繁口鼻吸引同样应该引起高度重视。Objective To discuss the characteristics and risk factors of coagulase-negative Staphylococci（ CNS） colonization in neonates.Methods Swab culture of nose,eye,umbilical cord,and rectum was performed once a week and culture of central venous catheter tip after removal was done to neonates treated in B ward of neonatal intensive care unit in Bejing Obstetrics and Gynecology Hospital from August2015 to May 2016. Clinical data of every neonates with CNS colonization was collected in experimental group and neonates with negative culture result were in control group. Multivariate linear regression analysis was used to assess high risk factors. Results Among 712 neonates in neonatal intensive care unit,CNS colonization occurred in 60 newborns（ 8. 4%）. Median number of days was 8（ interquartile range 4-13）. The most common CNS colonization site was nasopharynx（ n = 24）,followed by trachea tube（ n = 12）. CNS colonization single factor analysis showed that birth weight and gestational age in the experimental group were significantly lower than those in the control group（ t value was-17. 501 and-11. 518,respectively,both P〈0. 05）. Catheter utilization in the experimental group was significantly higher than that in the control group（ χ^2value was 34. 751,28. 229,14. 101 and 62. 484,respectively,all P〈0. 05）. Differences in gender,lower segment cesarean rate,admission age and omphalitis incidence between two groups were not statistical significant（ all P〈0. 05）. Linear regression analysis showed that gestational week（ P = 0. 042）,birth weight（ P = 0. 000）,peripherally inserted central venous catheter（ CVC）（ P = 0. 006）,nasal and/or oral aspiration（ P = 0. 011）,ventilator assisted breathing（ P = 0. 050）,and total parenteral nutrition（ P = 0. 015） were independent high risk factors of CNS colonization. Conclusion Preterm birth,low birth weight,use of ventilators,and central venous catheterization are high risk factors for CNS colonization. Meanwhile,attention sho

关 键 词：凝固酶阴性葡萄球菌 定植菌 皮肤黏膜损伤 败血症 

分 类 号：R722.1[医药卫生—儿科]