重症监护室及母婴同室新生儿医院感染的特点比较

Characteristics of nosocomial infections of neonate in neonatal intensive careunit and direct rooming-in

目的分析新生儿重症监护室(neonatal intensive careunit,NICU)及母婴同室(direct rooming-in,DRI)新生儿医院感染(nosocomial infections,NI)的临床特点及其可能原因,并为提高预防新生儿NI的措施以及经验性选用抗菌药物提供临床依据。方法回顾性比较2009年10月至2013年9月复旦大学附属妇产科医院NICU及DRI新生儿NI的发生率、感染部位、病原菌分布及对抗菌药物耐药的差异。结果NICU新生儿与DRI新生儿相比,早产新生儿比例显著较大(P<0.05)。NICU新生儿NI率(1.48%)与DRI(1.20%)无显著差异(1.48%vs 1.20%,P>0.05)。早产新生儿NI的发生率(12.34%)显著高于足月产新生儿(0.57%,P<0.01)。NICU早产新生儿NI的发生率(15.49%)显著高于DRI(11.80%,P<0.01)。NICU足月产新生儿NI的发生率(0.55%)与DRI(0.57%)无显著差异(P>0.05)。NICU新生儿下呼吸道感染、败血症、泌尿道感染、菌血症发生率显著高于DRI新生儿(P<0.05),NICU新生儿上呼吸道感染、皮肤感染、脐炎发生率显著低于DRI新生儿(P<0.05)。NICU和DRI新生儿NI病原菌均以革兰阴性菌为主,革兰阴性菌感染中大肠埃希菌占绝大多数;NICU新生儿NI革兰阳性菌以耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase negative staphylococcus,MRCNS)感染多见,而DRI新生儿NI革兰阳性菌以耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)多见,其次为MRCNS感染;真菌感染在NICU及DRI新生儿NI中占一定比例。结论 NICU早产新生儿是NI的高危人群。NICU新生儿易发生侵袭性相关NI。NICU和DRI新生儿NI病原菌分布不同,应尽可能选择敏感抗菌药物,再根据药敏试验结果调整。

Objective To analyse the clinical characteristics and possible causes of nosocomial infections of neonate in neonatal intensive careunit （NICU） and direct rooming-in（DRI）,so as to provide clinical evidence of preventing nosocomial infections （NI） of neonate and empirical selection of antibiotics.Methods A retrospective comparison was made for incidence,infection site,distribution of pathogenetic bacteria and drug resistance of （NI） of neonate in NICU and DRI in Obstetrics and Gynecology Hospital of Fudan University from Oct.,2009 to Sept.,2013.Results The proportion of premature neonate in NICU was larger than in DRI（P＜0.05）.There was no significant difference between the incidence of NI of neonate in NICU and in DRI（1.48％ vs 1.20％,P＞0.05）.The incidence of NI of premature neonate was higher than that of term neonate（12.34％ vs 0.57 ％,P ＜0.01）.The incidence of NI of premature neonate in NICU（15.49％） was higher than that in DRI （11.80％,P＜0.05）.There was no significance between the incidence of NI of term neonate in NICU and that in DRI （P ＞ 0.05）.The incidence of lower respiratory infection,septicemia,urinary tract infection and bacteremia in NICU was higher than that in DRI （P＜ 0.05）.The incidence of upper respiratory infection,skin infection and omphalitis in NICU was lower than that in DRI（P＜0.05）.The primary pathogenic bacterium of NI of neonate in NICU and DRI were gram-negative,in which the E.coli was in the majority.Methicillin resistant coagulase negative staphylococcus （MRCNS） was the most gram-positve bacteria in NI of neonate in NICU,while methicillin resistant staphylococcus aureus and MRCNS were the most two gram-positve bacteria in NI of neonate in DRI.Fungal infection took a certain proportion in NI of neonate in NICU and DRI.Conclusions Premature neonate in NICU was the high risk group of NI.Neonate in NICU was more likely to suffer from invasive operation related nosocomial infections.The distribution of pathogenetic bacteria of NI of neonate was different in NICU from in DRI.Antibiotics should be adjusted according to the drug sensitive test.