新生儿重症监护室早产儿医院感染的研究  

Nosocomial infections in premature infants of neonatal intensive care unit

作　　者：赵应红[1] 陈洪[1] 闵宗素 龙云[1] 叶素琴[1] 刘彩霞[1] 钟珊[1] 

机构地区：[1]遵义市妇幼保健院护理部,贵州遵义563000

出　　处：《中华医院感染学杂志》2017年第16期3787-3790,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨新生儿重症监护室早产儿医院感染的发生情况及其危险因素,为医院感染的预防控制提供依据。方法选取2014年1月-2015年12月医院新生儿重症监护室收治的438例早产儿作为临床研究对象,并对其临床资料予以回顾性分析。结果新生儿重症监护室438例早产儿中发生医院感染49例,感染率为11.19%;新生儿重症监护室早产儿医院感染基础疾病以新生儿肺炎和呼吸窘迫综合征为主,分别占44.90%和36.73%;新生儿重症监护室早产儿医院感染部位以呼吸道和皮肤为主,分别占40.82%和22.45%;感染患儿共检出病原菌46株,其中革兰阴性菌24株占52.17%,革兰阳性菌16株,占34.78%,真菌6株占13.04%;胎龄≤32周、出生体质量≤1 500g、机械通气>72h、胃肠外营养>7d、留置胃管、应用抗菌药物、喂养不耐受、住院天数>14d是新生儿重症监护室早产儿发生医院感染的危险因素(P<0.05),经logistic多因素回归分析,机械通气>72h、出生体质量≤1 500g、胎龄<32周、胃肠外营养是早产儿发生医院感染的独立危险因素。结论导致新生儿重症监护室早产儿发生医院感染的危险因素相对较多,发生医院感染的患儿其基础疾病以新生儿肺炎和呼吸窘迫综合征为主,肺炎克雷伯菌和金黄色葡萄球菌为引起医院感染的主要致病菌,加强对早产儿医院感染管理,合理化应用抗菌药物,对于降低早产儿医院感染具有重要意义。OBJECTIVE To explore the prevalence of nosocomial infections in premature infants of neonatal intensive care unit （NICU） and investigate the risk factors so as to provide guidance for prevention and control of nosocomial infections.METHODS A total of 438 premature infants who were treated in NICU from Jan 2014 to Dec 2015 were recruited as the study objects, and the clinical data of the study objects were retrospectively analyzed.RESULTS Of the 438 premature infants who were treated in the NICU, 49 had nosocomial infections, with the infection rate 11.19%.Among the premature infants who had underlying disease, 44.90% had neonatal pneumonia, and 36.73% had respiratory distress syndrome.The premature infants with respiratory tract infection accounted for 40.82%, and the premature infants with skin infection accounted for 22.45%.Totally 46 strains of pathogens were isolated from the premature infants with infections, of which 52.17% （24 strains） were gram-negative bacteria, 34.78% （16 strains） were gram-positive bacteria, and 13.04% （6 strains） were fungi.The risk factors for nosocomial infections in the premature infants of NICU included the gestational age no more than 32 weeks, birth weight no more than 1 500g, mechanical ventilation duration more than 72 hours, more than 7 days of parenteral nutrition, gastric tube indwelling, use of antibiotics, feeding intolerance, and more than 14 days of hospitalization duration （P〈0.05）.The multivariate logistic regression analysis showed that the more than 72 hours of mechanical ventilation, no more than 1 500 g of birth weight, less than 32 gestational weeks and pareteral nutrition were the independent risk factors for the nosocomial infection in the premature infants.CONCLUSION There are a variety of risk factors for nosocomial infections in the premature infants of NICU.The neonatal pneumonia and respiratory distress syndrome are the predominant underlying diseases, Klebsiella pneumoniae and Staphylococcus aureus are dominant among the pathogens ca

关 键 词：医院感染 早产儿 重症监护 新生儿 

分 类 号：R722.13[医药卫生—儿科]