新生儿院内血流感染的调查与分析

Investigation and analysis on nosocomial bloodstream infection in neonates

目的：了解新生儿院内血流感染的危险因素、病原菌及其耐药谱,为有效防治提供科学依据。方法：采用回顾性调查方法,调查分析武汉某医院2010～2013年新生儿病房发生院内血流感染149例患儿的临床资料、微生物检查结果。结果：新生儿院内血流感染前三位最常见的病原菌依次为：凝固酶阴性葡萄球菌（31.8%）、金黄色葡萄球菌（23.2%）、大肠埃希菌（18.5%）,G-菌及真菌感染的比例有增加趋势;G＋菌对青霉素及红霉素大部分耐药,对万古霉素均敏感;G-菌对氨苄西林及头孢菌素高度耐药,对亚胺培南敏感;发生院内血流感染的独立危险因素为：早产（〈32周）、出生体重≤1 500 g、中心静脉置管及气管插管。结论：新生儿院内血流感染病原菌中G-菌及真菌感染有增加趋势,病原菌多重耐药严重,新生儿病房应严格消毒隔离措施及无菌操作原则,严格各种留置导管适应证,避免院内血流感染的发生。

Objective： To understand the risk factors,pathogenic bacteria and drug resistance of nosocomial bloodstream infection in neonates and provide scientific evidence for effective prevention and treatment. Methods： The clinical data and microbiological examination results in 149 neonates with nosocomial bloodstream infection in neonatal wards of a hospital in Wuhan from 2010 to 2013 were analyzed and investigated retrospectively. Results： The three most common pathogenic bacteria of nosocomial bloodstream infection in neonates were listed as follows： coagulase negative staphylococcus（ 31. 8%）,staphylococcus aureus（ 23. 2%） and Escherichia coli（ 18. 5%）. The ratios of infections with Gram- negative bacteria and fungi showed increasing trends. Most Gram- positive bacteria were resistant to penicillin and erythrocin,all the Gram- positive bacteria were sensitive to vancomycin. Gram- negative bacteria were highly resistant to ampicillin and cephalosporin,all the Gram- negative bacteria were sensitive to imipenem. The independent risk factors for nosocomial bloodstream infection in neonates were premature birth（ 32 gestational weeks）,birth weight≤1 500 g,central venous indwelling catheter and tracheal intubation. Conclusion： Nosocomial bloodstream infections with Gram- negative bacteria and fungi show increasing trends in neonates,multi-drug resistance of pathogens is serious. Strict disinfection and isolation measures,the principle of aseptic technique and strict catheter indications in neonatal wards may avoid the occurrence of nosocomial bloodstream infection in neonates.