新生儿机械通气细菌学监测结果与医院感染的相关性

Correlation between bacteriologic monitoring results for neonatal mechanical ventilation and hospital infections

目的明确新生儿机械通气后细菌学监测结果与医院感染发生的相关性,为新生儿机械通气后发生医院感染的预防控制提供依据。方法选择2007年8月-2012年8月医院新生儿科住院的68例机械通气患儿,根椐不同时间段的气管插管方式、机械通气时间、患儿的性别、年龄、体质量等方面监测患儿呼吸道细菌学检测结果与医院感染发生的相关性。结果 6 578例住院治疗的新生儿中共发生医院感染67例,感染率1.01%,感染部位以呼吸道为主占55.22%;细菌培养阳性率与患儿的性别无关,其胎龄越小、体质量越低、通气时间越长、机械通气上机次数越多,通气过程中细菌阳性率越高,经鼻气管插管患儿细菌阳性率也高于经口插管者,差异有统计学意义(P<0.05);插管后不同时间点所采集的198份气道分泌物,细菌培养总阳性率为29.79%;共培养出病原菌59株,其中革兰阴性菌42株占71.19%、革兰阳性菌11株占18.64%、真菌6株占10.17%。结论机械通气期间容易并发呼吸道感染,增加医院感染率;新生儿机械通气后细菌学监测结果与医院感染发生具有显著的相关性,有效规范细菌学监测结果为医院感染的监测与治疗提供有效临床保证。

OBJECTIVE To clarify the correlation of the bacteriologic monitoring results for neonatal mechanical ventilation and hospital infections, so as to provide reference for prevention and control of hospital infections after mechanical ventilation in newborns. METHODS The 68 cases of newborn with mechanical ventilation from Aug. 2007 to Aug. 2012 were enrolled. The correlation of the bacteriologic monitoring results and hospital infections was investigated from aspects such as approaches of tracheal intubation at different time periods, mechanical ventilation time, newborn genders, age, and weight. RESULTS In 6578 newborns hospitalized, 67 cases had nosocomial infections, the total incidence was 1.01%. Respiratory tract was the main infection site accounting for 55.22 %. The bacteria positive culture rate was not correlated with newborn genders. The bacteria positive culture rate was higher along with younger gestational age, lower weight, longer mechanical ventilation and more frequent mechanical ventilation. And the positive culture rate was higher in nasal and tracheal intubation than oral intubation, the difference was significant （P〈0.05）. The total positive culture rate was 29.79 % in 198 specimens of the airway secretions collected at different time points after intubation. A total of 59 pathogens were cultured including 42 gram-negative bacteria （71. 19%）, 11 gram-positive bacteria （18. 64%） and 6 fungi （10. 17%）. CONCLUSION Respiratory tract infection is likely to occur in the process of mechanical ventilation and increase the hospital infection. There is significant correlation between the bacteriologic monitoring results for neonatal mechanical ventilation and hospital infection. Effective and normative bacteriologic monitoring results can provide an effective clinical guarantee for monitoring and treatment of hospital infections.