新生儿重症监护病房医院感染的危险因素分析

Analysis of risk factors for nosocomial infections in neonatal intensive care unit

目的通过对新生儿重症监护病房医院感染病例的危险因素进行回顾性分析,为预防和控制新生儿医院感染提供科学依据。方法收集本院新生儿重症监护病房2008年1月至2012年6月收治的1186例患儿资料,对确诊为院内感染患儿的流行病学资料、住院期间的临床资料及实验室相关检测结果进行回顾性分析。结果 1186例新生儿患者中有85例患儿存在医院感染,医院感染发生率为7.17%;病原菌以革兰阴性菌最多见(53/85,62.4%),主要为肺炎克雷伯菌(18/85,21.2%)、鲍曼不动杆菌(12/85,14.1%)、铜绿假单胞菌(7/85,8.2%)和大肠埃希菌(5/85,5.9%)。本组病例院内感染的临床表现以肺炎(35/85,41.2%)最为常见,其中呼吸机相关性肺炎占所有肺炎的68.6%(24/35);其次为败血症(22/85,25.9%)和腹泻(12/85,14.1%)。多元Logistic回归分析结果显示,机械通气(OR=1.921)、脐静脉置管(OR=1.301)、住院时间(OR=1.076)、胎龄(OR=1.125)和胎膜早破(OR=1.207)等是新生儿发生院内感染的主要危险因素。结论新生儿院内感染的病原菌以革兰阴性菌为主;缩短机械通气和住院时间,尽早拔除静脉置管可降低新生儿院内感染发病率。

Objective To investigate the risk factors of nosocomial infections for newborn infants and provide scientiifc basis for infection prevention and control. Methods Datas of 1186 newborn infants hospitalized in neonatal intensive care unit of our hospital from January 2008 to June 2012 were screened;and the epidemiological and clinical characteristics, results of etiological examinations of conifrmed cases were analyzed retrospectively. Results Total of 1186 cases were screened, and nosocomial infection occurred in 85 patients with 7.17% overall nosocomial infection rate. The most common pathogens were gram-negative bacteria （53/85, 62.4%）, in which Klebsiella pneumoniae （18/85, 21.2%） was predominant, followed by Acinetobactor baumannii （12/85, 14.1%）, Pseudomonas aeruginosa （7/85, 8.2%） and Escherichia coli （5/85, 5.9%）. Among 85 patients, pneumonia which was the most common nosocomial infection in neonatal ward, which accounts for 41.2%（35/85）, including ventilator-associated pneumonia （VAP） （24/35, 68.6%）, sepsis （22/85, 25.9%） and diarrheal disease （12/85, 14.1%）. Logistic regression analysis showed that mechanical ventilation （OR=1.921）, umbilical vein catheter （OR=1.301）, hospitalization days （OR=1.076 ）, gestational age （OR=1.125） and premature rupture of membrane （OR= 1.207 ） were the risk factors for the development of nosocomial infection. Conclusions The main pathogens of nosocomial infections for newborn infants were gram-negative bacteria;and shortening the time of mechanical ventilation and hospitalization days, removal of the central venous catheter as early as possible is helpful to reduce the occurrence of nosocomial infection.