新生儿重症监护室早产儿医院内感染903例临床分析

Analysis of hospital acquired infection in neonatal intensive care unit

目的研究新生儿重症监护室（NICU）早产儿医院内感染的发生情况及其相关危险因素。方法对2006年8月至2010年10月于本院NICU住院的903例早产儿的住院资料进行回顾性分析，采用Logistic多因素回归分析医院内感染的危险因素，并对医院内感染的部位及病原进行分析。结果903例早产儿中110例发生123次院内感染，发生率为12．2％，病死率2．7％；日医院感染率为7．3‰；医院内感染者平均感染发生时间为住院后（15．03±11．85）d。NICU早产儿医院内感染的危险因素包括胎龄≤32周、出生体重≤1500g、无创机械通气、气管插管、留置脐静脉导管、留置外周放置中心静脉导管、肠外营养。感染部位以败血症占首位（45．5％），其次为下呼吸道感染及结膜炎。123例次医院内感染共获得70株培养阳性标本，病原菌以细菌为主，其中革兰阳性菌35株（50％），革兰阴性菌33株（46％）。结论NICU早产儿医院内感染的预防在于重视早产儿规范化管理、规范中心静脉导管、脐静脉导管等侵入性操作，减少气管插管机械通气。

Objective To analyze the prevalence of hospital acquired infection and the associated risk factors. Methods Nine hundred and three hospitalized preterm infants in our neonatal intensive care unit from August 2006 to October 2010 were retrospectively studied. Risk factors of hospital acquired infection were analyzed by single factor analysis and logistic regression analysis method. Site and pathogen of infection were also analyzed. Results One hundred and ten preterm infants developed 123 times of hospital acquired infection. The incidence of hospital acquired infection was 12. 2%, and hospital acquired infection patient-day rates was 7. 3‰. The mortality was 2. 7%. Gestational age less than 32 weeks,birth weight less than 1500 gram, non-invasive ventilation, tracheal intubation, umbilical vein catheter （ UVC ）, peripherally inserted cen- tral catheter（ PICC）, parenteral nutrition were the risk factors of hospital acquired infection. Logistic regres- sion analysis showed mechanical ventilation, UVC and PICC were the main risk factors. The main sites of in- fection were sepsis （ 45.5 % ）, low respiratory infection and conjunctivitis. Seventy positive culture samples were obtained. Bacteria were the main pathogen. Fifty percent was gram-staining positive, while 46% was gram-staining negative. Conclusion It is very important to identify the high risk factors for hospital acquired infection. Standardized management of preterm infants, standardized usage of umbilical vein catheter and pe- ripherally inserted central catheter, minimized usage of intubation would be conductive to reduce the incidence of hospital acquired infection.