新生儿重症监护室医院感染分析

Analysis of nosocomial infection in NICU

目的分析新生儿重症监护室医院感染的危险因素、特点及预防措施。方法对2004～2006年我院新生儿重症监护室发生医院感染83例新生儿病历进行回顾性总结分析。结果总医院感染率3.39%,早产儿医院感染率5.27%,足月儿医院感染率2.79%。感染部位主要以呼吸道及血液为主。医院感染患儿中有病原学诊断者47例,共检出细菌39株,革兰阴性菌33株(84.6%),以肺炎克雷伯氏菌为主,革兰阳性菌6株(15.4%),以表皮葡萄球菌为主。病毒16株,其中轮状病毒15株,呼吸道合胞病毒1株。医院感染革兰阴性菌对碳青霉烯类敏感,革兰氏阳性球菌对万古霉素敏感,均对青霉素及第二、三代头孢菌素耐药率高。发生医院感染患儿97%住院初期均使用第二、三代头孢菌素防治感染。结论早产儿医院感染率明显高于足月儿医院感染率,医院感染的菌株耐药性高。严格控制预防性使用广谱抗生素,是预防新生儿监护室医院感染的关键。

Objective To analyze the risk factors, characteristics and preventive methods of nosocomial infection in NICU. Methods From 2004 to 2006, the data of 83 cases with nosocomial infection were retrospectively analyzed. Results Total nosocomial infection rate was 3.39%; The rate of premature infants infection was 5.27%; Full-term infants nosocomial infection rate was 2.79%. The respiratory tract and blood infection were the main causes. Forty-seven cases were diagnosed by nosocomial infection pathogen, and 39 strains of bacterial were detected. In 33 （84.6%）Gram-negative bacilli, Klebsiella pneumoniae bacteria was the most common and in 6 （15.4%） Gram-positive bacilli the most common was staphylococcus. The number of virus was 16, among them 15 were rotavirus, 1 of the respiratory syncytial virus. Gram-negative bacteria nosocomial infection was sensitive to carbapenem, and Gram-positive cocci was sensitive to vancomycin with the high rate of resistance to the second and third generation of cephalosporin. Ninety-seven percent of the nosocomial infected children were initally treated wtih the second and the third generation of cephalosporin. Conclusions The nosocomial infection rate of the premature infants was significantly higher than that of full-term infants （OR=1.35, P 〈 0.01）. Nosocomial infection resistant strains are high. The keys of preventing infection in neonatal intensive care unit include special attention to nosocomial infection control for premature infants and strictly control of preventive usage of broad-spectrum antibiotics.