新生儿重症监护室极低出生体质量儿院内感染的变迁

Change of Nosocomial Infection of Very Low Birth Weight Infants in Neonatal Intensive Care Unit

目的探讨新生儿重症监护室(NICU)极低出生体质量儿(VLBWI)院内感染的流行病学情况、危险因素和结局等的变化趋势,以便对近年院内感染的相关情况有新的认识。方法回顾性分析1998年1月1日-2008年12月31日北京大学第三医院NICU收治的出生体质量<1500g且住院时间>48h的VLBWI的临床资料。将11a分为2个阶段:1998年1月1日-2003年12月31日为第1阶段,2004年1月1日-2008年12月31日为第2阶段;每个阶段根据是否发生院内感染均分为未感染组和感染组,采用SPSS12.0软件分别对2个阶段及每阶段2组患儿的临床资料进行比较分析。结果第1阶段VLBWI31例,发生院内感染者10例;第2阶段127例,发生院内感染者46例;感染发生百分比分别为32.3%和36.2%,2阶段院内感染发生率比较差异无统计学意义(P=0.679)。2个阶段败血症构成比较差异有统计学意义(P<0.05)。第1阶段院内感染患儿检出细菌均为革兰阴性(G-)杆菌;第2阶段检出细菌中G-杆菌占52.6%,革兰阳性(G+)球菌占50.0%。在第1阶段未得出与院内感染相关的危险因素。第2阶段得出胎龄、出生体质量、机械通气、气管插管辅助呼吸、肠道外营养、外周导入中心静脉置管、脐静脉置管、先天性心脏病和RDS均与院内感染相关。第2阶段显示外周导入中心静脉置管、脐静脉置管与败血症的发生有一定关联。第2阶段中使用机械通气和肠道外营养是VLBWI院内感染的独立危险因素。结论随着VLBWI存活率的提高,院内感染发生率并未显著增加,但有上升趋势,发现院内感染的相关因素和流行病学变化特征,将更有针对性的防治VLBWI院内感染。

Objective To explore the change trends of epidemiological and clinical feature,risk factors,outcome of nosocomial infection of very low birth weight infant（VLBWI） in neonatal intensive care unit （NICU）.Methods The VLBWI whose birth weight were less than 1 500 g and whose length of stay were more than 48 hours were selected in this study in NICU of Peking University Third Hospital within 11 years（from Jan.1,1998 to Dec.31,2008）.The related clinical informations of VLBWI were recorded and analyzed in detail.Eleven years were divided into 2 phase,the first phase was from Jan.1,1998 to Dec.31,2003 and the second phase was from Jan.1,2004 to Dec.31,2008.In each phase,the infants were divided into 2 groups according to nosocomial infection as infection group and non-infection group.The data from 2 phases and 2 groups were analyzed by SPSS 12.0 software.Results There were 31 cases and 127 cases of VLBWI in 2 phases,respectively.There were 10 cases and 46 cases who had nosocomial infection in 2 phases,respectively.There were no significant difference in the incidence percentage for nosocomial infection between 2 phases （32.3% vs 36.2%,P=0.679）.There were significant difference in the constituent ratio of septicemia between 2 phases （P〈0.05）.In the first phase,the isolated bacteria were all gram-negative bacillus,and in the second phase gram-negative bacillus accouted for 52.6% and gram-positive cocci accouted for 50.0%.In the first phase,the factors correlated with nosocomial infection were not achieved.In the second phase,the factors correlated with nosocomial infection in VLBWI were gestational age,birth weight,mechanical ventilation,ventilatory support with trachea cannula,parenteral nutrition,central vein cannula,congenital heart disease,respiratory distress syndrome and the duration of parenteral nutrition,central vein cannula,mechanical ventilation and trachea cannula.The central vein cannula was significantly correlated with septicemia in the second phase（P〈0.05）.The Logistic regression analysis showed that mechanical ventilation and parenteral nutrition were the most significant risk factors in the second phase.Conclusions The incidence percentage for nosocomial infection dose not increase but presents an ascending trend with the increase of survival rate of VLBWI.The change of characteristics of the factors and epidemiological features correlated with nosocomial infection are found,so as to prevent and treat nosocomial infection of VLBWI with the definite direction.