极低和超低出生体质量儿医院感染的十年变迁

Change of Nosocomial Infection of Very Low or Extremely Low Birth Weight Infants in the Last 10 Years

目的探讨新生儿重症监护病房(NICU)极低和超低出生体质量儿医院感染的流行病学情况及病原菌的变化趋势。方法回顾性分析2001年1月—2010年12月在我院NICU住院的654例极低和超低出生体质量儿的医院感染发生情况,将发生医院感染的162例极低和超低出生体质量儿分为2001年1月—2005年12月和2006年1月—2010年12月两组,对比分析两组医院感染的发病率、感染疾病和病原菌的变迁。结果第一组和第二组医院感染发生率分别为22.55%和26.01%,两者间差异无统计学意义(P>0.05)。两组医院感染疾病均以肺炎为主,前后五年比较所占比例有所下降,但两者间差异无统计学意义(P>0.05);败血症的构成比由22.6%增加至38.5%,两者间差异有统计学意义(P<0.05)。两组病原菌均以革兰阴性菌为主,前后五年构成比显示革兰阳性菌和真菌呈上升趋势,肺炎克雷伯杆菌成为第一位的医院感染致病菌,凝固酶阴性葡萄球菌明显上升,差异有统计学意义(P<0.05)。结论极低和超低出生体质量儿医院感染发生率有上升趋势,败血症构成比增加,应根据病原菌谱的变化合理应用抗生素。

Objective To investigate the change trends of pathogens and epidemiological condition of nosocomial infection（NI） of very low or extremely low birth weight infants in neonate intensive care unit（NICU）.Methods The data of 654 very low or extremely low birth weight infants in NICU of our hospital from January 2001 to December 2010 were investigated retrospectively.The 162 infants diagnosed with nosocomial infection were divided into 2 groups according to their hospitalization periods：from 2001 to 2005（group I） and from 2006 to 2010（group Ⅱ）.The NI rate,infected site and pathogens were comparatively analyzed between the two groups.Results The NI rate was 22.55% in group I and 26.01% in group Ⅱ,with no statistical difference（P〉0.05）.The most common infection was pneumonia,and the proportion of pneumonia in the late 5 years decreased,but with no statistical difference（P〉0.05）.However the proportion of sepsis increased from 22.6% to 38.5%（P〈0.05）.The major pathogens of NI were gram-negative bacteria in the two groups,and the proportion of gram-positive bacteria and fungus had increased,Klebsiella pneumoniae became the forst pathogen to cause NI,and coagulase negative staphylococcus increased significantly（P〈0.05）.Conclusion The NI rate in very low or extremely low birth weight infants presents an ascending trend,and the constituent ratio of sepsis increases.So the antibiotics should be rationally chosen according to the change of pathogenic spectrum.