超早产儿医院感染及其危险因素分析

Clinical analysis of nosocomial infection and risk factors of extremely premature infants

目的 探讨新生儿重症监护病房超早产儿医院感染的危险因素.方法 对2008年1月至2012年12月收住温州育英儿童医院新生儿重症监护病房的超早产儿135例进行回顾性分析,去除住院时间不满48 h的17例,共118例超早产儿纳入研究.对医院感染发生率、感染的临床特点、危险因素等进行分析.结果 118例超早产儿中发生感染78例,感染率为66.10％,感染例次数129次,例次感染率为109.32％.其中,呼吸机相关性肺炎患病率为1.43％ （35/2 452）,导管相关性血流感染患病率为0.35％（16/4 613）.超早产儿医院感染疾病以肺炎居首位,共74例次,占57.36％ （74/129）,其中呼吸机相关性肺炎35例次,占肺炎47.30％;其次为败血症48例次.共检出90株病原菌,以革兰阴性菌为主[74株（82.22％）],其次为革兰阳性菌12株,真菌4株;肺炎克雷伯菌是超早产儿医院感染最常见病原菌,超广谱β内酰胺酶（ESBL）阳性率达90.91％（20/22）,对头孢菌素类均耐药.经单因素分析显示,超早产儿医院感染的危险因素为体重、机械通气、脐静脉置管、中心静脉置管、胃肠外营养时间及住院时间.进一步Logistic回归分析提示,住院时间（OR=1.024,P=0.043）及中心静脉置管（OR =6.170,P=0.041）是超早产儿医院感染的独立危险因素.78例医院感染超早产儿中死亡12例,病死率15.38％.结论 超早产儿是医院感染的高危人群,充分了解其医院感染的危险因素,缩短机械通气、中心静脉置管时间及住院时间可降低医院感染发生率.

Objective To investigate the incidence of nosocomial infections of extremely premature infants and to explore the risk factors and strategies for infection control.Method There were 118 extremely premature infants who were confirmed to have nosocomial infection in neonatal intensive care unit of the authors＇ hospital from January 2008 to December 2012.Their data of the infection rate,risk factors and clinical characteristics were retrospectively analyzed.Result During the study,nosocomial infection occurred in 78 extremely premature infants 129 times.The nosocomial infection rate was 66.10%.The rate of ventilator-associated pneumonia （VAP） was 1.43% （35/2 452）.The catheter related blood stream infection （CRBSI） rate was 0.35% （16/4 613）.There were 74 （57.36%） cases of pneumonia,which was the most common nosocomial infection of extremely premature infants.There were 35 cases of VAP,which accounted for 47.30% of pneumonia.The next was sepsis,48 cases.Seventy-four （74/90,82.22%）strains of isolates were Gram-negative bacteria,which accounted for the highest proportion,followed by Gram-positive （12 strains）,fungus （4 strains） ; Klebsiella pneumonia is the most common pathogens of nosocomial infection in extremely premature infants.The isolation rates of Klebsiella pneumonia with positive extended-spectrum beta-lactamases （ESBL） were 90.91% （20/22）,universally resistant to cephalosporins.Single-factor analysis showed that the body weight,mechanical ventilation,umbilical vein catheterization,central venous catheter,parenteral nutrition and hospitalization time were risk factors for nosocomial infections in extremely preterm infants.Logistic regression analysis showed that length of hospitalization （OR =1.024,P =0.043） and central venous catheterization （OR =6.170,P =O.04 1） were independent risk factors of nosocomial infection.Conclusion Extremely preterm infants were at higher risk of nosocomial infection.It is important to identify the high risk factors for nosocomial infections in extremely premature infants.To shorten time for mechanical ventilation,central venous catheterization and hospitalization days would be conducive to reducing the morbidity of nosocomial infection.