极低出生体重儿院内感染状况及原因分析

Characteristics and risk factors of nosocomial infections in VLBWI

目的探讨极低出生体重儿（verylowbirthweightinfant，VLBWI）院内感染特征，分析感染发生的可能危险因素，以便采取针对性的预防对策。方法回顾性调查2012年1～6月本院重症监护病房58例VLBWI感染发生情况、感染特征及感染发生的原因。结果58例WLBWI住院期间院内感染发生率为60．34％，感染病原菌主要为革兰氏阳性菌（占88．47％），以肺部感染（占82．90％）为主；感染时间主要在出生后21d内。机械通气、经外周静脉置管术（peripherallvinsertedcentralcatheter,PICC）、阿氏评分≤7分、使用氟康唑及胎膜早破的VLBWI感染率较高（均P〈o．05）。结论VLBWI感染发生率较高，主要为肺部感染，发生时间主要集中在出生后21d内；机械通气、PICC、阿氏评分低、胎膜早破等是VLBWI感染的主要因素。应加强VLBWI出生后3W内的感染控制，尽量减少对患儿的侵入性操作，合理使用抗生素，同时加强围生期保健，降低早产发生率。

Objective To explore the characteristics of nosocomial infection and its related factors among those very low birth weight infant （VLBWI） for coming up with appropriate preventive measures. Methods Fifty-eight infants with birth weight of 1500 g or below in the hospital from January to June in 2012 were studied actively and retrospectively about their nosocomial infection and related risk factors. Results Thirty-five cases of nosocomial infection occurred among the 58 infants with a prevalence of 60.34%. The mainly pathogenic bacteria was Gram-positive bacteria （88.47%）and mostly, infections presented with lung infections （82.90%） within 21 days after birth. The risk factors included mechanical ventilation, PICC, Apga score 〈 7, fluconazole administration and premature rupture of membranes of VLBWI. Conclusions VLBWI are prone to nosocomial infections, mostly lung infection on day 21 after birth. Management should be strengthened within 3 weeks after birth of VLBWI to minimize infections. Reduction of invasive procedures on children and antibiotic use is particularly important. On the other hand, strengthening the health care in the perinatal period and reducing the incidence of preterm birth cannot be ignored.