儿童医院感染病原菌分布及危险因素分析

Distribution of pathogens causing nosocomial infections in children and analysis of risk factors

目的研究住院患儿康复进程中医院感染病原菌的部位来源及分布,病原菌的耐药性以及医院感染发生的危险因素,指导临床控制和治疗患儿康复进程中的医院感染。方法选取2011年1月-2012年12月医院368例住院患儿,观察发生感染患者分离培养的病原菌采用BACTECTM9000培养系统进行分离鉴定,并采用KB琼脂法进行药敏试验,结果判定严格按照NCCLS 2005年版进行;对比感染患儿的相关因素,计数资料比较采用χ2检验,采用SPSS 18.0进行数据统计分析。结果 368例住院患儿疾病康复进程中发生医院感染126例,感染率为34.24%;共检出病原菌138株,其中革兰阳性菌62株占44.93%,革兰阴性菌76株占55.07%;住院患儿康复进程中医院感染的革兰阳性菌对替莫唑胺和乙酰唑胺的耐药率较低,革兰阴性菌对美罗培南和替考拉宁的耐药率较低,均<8.00%;住院时间长、患有其他疾病、尿管留置时间长、进行侵入性操作、应用糖皮质激素或免疫抑制剂、未预防性应用抗菌药物、使用呼吸机等,是发生感染的危险因素。结论住院患儿疾病康复中医护工作人员首先应严格控制医院感染的发生,当感染发生时及时分离培养病原菌进行药敏试验,以合理选择抗菌药物进行治疗。

OBJECTIVE To study the distribution of pathogenic bacteria causing nosocomial infections in the hospitalized children during rehabilitation, analyze drug resistance of the pathogens, and explore the risk factors for nosocomial infections to provide guidance for clinical control and treatment of the nosocomial infections. METHODS Totally 368 children who were hospitalized from Jan 2011 to Dec 2012 were enrolled in the study, then the cases of infections were observed, the isolation and culture of pathogens were preformed with the BACTECTM 9000 culture system, the drug susceptibility testing for the isolated pathogens was carried out by using K-B agar method, the result was determined according to NceLS （2005 edition）, the related factors for the infections were compared, the chi-square test was performed for the comparison of count tat data, and the data were processed by using SPSS18. 0 software. RESULTS Among the 368 hospitalized children, the nosocomial infections occurred in 126 cases during the rehabilitation with the infection rate of 34. 24%. A total of 138 strains of pathogens were isolated, including 62 （44.93%） strains of gram-positive bacteria and 76 （55.07%） strains of gram-negative bacteria. The drug resistance rates of the gram-positive bacteria to temozolomide and acetazolamide were less than 8. 00 %, the drug resistance rates of the gram-negative bacteria to meropenem and teicoplanin were less than 8. 00 %. The longer hospitalization, complication of other disease, long-term catheter indwelling, invasive operation, use of corticosteroids or immunosuppressants, lack of prophylactic use of antibiotics, and use of ventilator were the risk factors for the nosocomial infections in the children, with statistical significance. CONCLUSION It is the priority for the medical staff in the rehabilitation center to strictly control the nosocomial infections. Once the infections occur, the isolation and culture of pathogens should be performed in a timely manner, the drug susceptibility testing should be carried out, and the antibiotics should be reasonably used.