新生儿医院感染目标性监测结果分析

Targeted surveillance of nosocomial infection in neonatal wards

目的了解新生儿医院感染现状、特征及相关危险因素,探讨有效的预防控制措施。方法采用主动监测的方法,对本院2010年1月至2012年8月所有住院新生儿进行目标性监测,包括住院患儿数、住院日数、医院感染例数及病原菌分布等,并对结果进行统计分析。结果研究期间共收治新生儿8067例,总住院日83110天,发生医院感染598例、640例次,新生儿医院感染率7.41%,7.20例次/1000住院日,3年间医院感染率差异无统计学意义。医院感染率随着出生体重的升高而降低,以新生儿感染为主(44.1%),其次为胃肠道感染(19.7%)、下呼吸道感染(16.7%),呼吸机相关性肺炎及导管相关性败血症感染率分别为13.09/1000呼吸机使用日和32.26/1000导管日,随着出生体重的升高,呼吸机相关性肺炎的感染率降低。医院感染病原菌主要为革兰阴性杆菌,占45.0%,尤以肺炎克雷伯菌为主,革兰阳性菌占38.8%,主要为葡萄球菌,真菌占16.3%。住院天数(OR=1.061,95%CI1.053～1.069)和侵入性操作(OR=1.858,95%CI1.408～2.449)为医院感染的独立危险因素,出生体重(OR=0.342,95%CI0.307～0.381)为保护因素(P均<0.001)。结论新生儿医院感染与多个因素有关,目标性监测应长期坚持进行,针对危险因素制定一系列的防控措施对预防医院感染的发生尤为重要。

Objective To achieve better understanding of the current status, features and risk factors of nosoeomial infection （ NI ） of neonates, to explore effective prevention and control measures. Methods According to the NI surveillance norms, the targeted surveillance of newborns admitted to the hospital from January 2010 to August 2012 was performed using active monitoring method, and the results were analyzed statistically. Results Total of 8067 neonates were included, and the total hospital stay added to 83 110 days. 598 neonates had 640 episodes of NI. The NI rate was 7. 41%. NI incidence every thousand-day was 7. 20, and there was no significant difference of NI rate during the three years. The incidence of nosocomial infection was reduced with increased birth weight. The most common nosocomial infection was neonatal infection （44. 1% ）, gastrointestinal tract （ 19. 7% ） and lower respiratory tract （16. 7% ） repres that rank second and third. The incidences of ventilator-associated pneumonia （VAP） and catheter-related bloodstream infection （CRBSI） were 13.09%o and 32. 26%v. The VAP rate was reduced with higher birthweight. The most common pathogen of nosocomial infection was Gram-negative bacilli（45.0%）, especially Klebsiella pneumoniae, and the Staphylococcus aureus was the major pathogen of Gram-positive bacteria （38. 8% ）, and the fungi accounted for 16. 3% of total NI. The duration of hospitalization（ OR = 1. 061,95% CI 1. 053 - 1.069） and invasive procedures（ OR = 1. 858,95% CI 1. 408 2. 449） served as independent risk factors for NI, and birth weight （OR =0. 342,95% CIO. 307 -0. 381 ）as a protective factor. Conclusions Multiple factors were associated with neonatal nosocomial infection. The targeted monitoring should be performed for long-term. It is of particular importance to develop a range of prevention and control measures focusing on risk factors associated with NI.