早产儿医院感染的危险因素

Risk Factors for Nosocomial Infections of Preterm Infants

目的探讨早产儿医院感染的发病情况及危险因素,为医院感染的监控和干预提供理论依据。方法回顾性调查本院2008年1月-2010年1月本院NICU 516例早产儿的临床资料,分析医院感染的危险因素。结果 1.早产儿516例中,74例发生医院感染,发生率为14.3%,共发生医院感染98例次,平均每例发生1.32次,医院感染的住院日相关发生率为8.9‰;感染部位以呼吸道为主(51.0%),其中呼吸机相关性肺炎最为多见(占36.0%),其次为皮肤软组织(26.5%)和消化道(14.3%)。2.共培养出病原菌69株,革兰阴性杆菌占71.0%,以肺炎克雷伯菌最为多见(17.4%);革兰阳性球菌占18.8%,以草绿色链球菌最为多见;真菌占10.1%,主要为白色念珠菌。3.胎龄≤32周、出生体质量≤1.5 kg、羊水胎粪污染、胎膜早破≥48 h、糖尿病母亲儿、吸痰次数≥10次、气管插管次数≥3次、机械通气时间≥3 d、置胃管、静脉营养、应用抗生素时间≥2周及住院时间≥2周与医院感染率显著相关,多元Logistic回归方程显示胎龄≤32周、静脉营养、机械通气时间≥3 d及住院时间≥2周是医院感染发生的独立危险因素。结论 NICU早产儿医院感染的危险因素众多,尽量减少侵入性操作次数、缩短静脉营养及住院的时间、合理应用抗生素可有效降低医院感染发生率。

Objective To explore the risk factors for nosocomial infections of preterm infants and explore the management in neonatal intensive care unit（NICU）.Methods A retrospective analysis was performed among 516 preterm infants in NICU,Provincial Hospital Affiliated to Shandong University from Jan.2008 to Jan.2010,the risk factors for nosocomial infections of preterm infants were analyzed.Results 1.There were 98 times of nosocomial infections in 74 preterm infants,and the incidence rate of nosocomial infections was 14.3%,the incidence density was 8.9 per 1 000 patient days.Tract was most frequent（51.0%）,among which 36.0% was ventilator-associated pneumonia,followed by skin and soft tissues（26.5%） and digestive tract infections（14.3%）.2.The most frequently isolated pathogens were gram-negative bacteria（71.0%）,klebsiella pneumoniae isolates accounted for 17.4%.The proportion of gram-positive and fungal organisms were 18.8% and 10.1% respectively.3.Univariate analysis indicated that gestational age ≤32 weeks,birth weight ≤1.5 kg,premature rupture of fetal membrance≥48 h,parenteral nutrition,virulence manipulations,duration of antibiotics and hospitalization≥2 weeks,were risk factors for nosocomial infections.Multivariate logistic regression analysis identified that gestational age≤32 weeks,the parenteral nutrition,mechanical ventilation≥3 d and duration of hospitalization≥ 2 weeks were the independent risk factors.Conclusions There are many risk factors of no-socomial infections of preterm infants.So effective methods should be taken to decrease or control the rate of neonatal infection.Reducing the duration of the parenteral nutrition,hospitalization and the virulence manipulation as far as possible and rational clinical drug administration in NICU may be conducive to decrease the incidence of nosocomial infections in preterm infants.