NICU新生儿院内感染情况及危险因素分析

Nosocomial infection investigation and risk factors in neonatal intensive care unit

目的通过分析该院新生儿重症监护室（NICU）2012年1月至2013年10月新生儿院内感染的发生情况，探讨院内感染发生的危险因素。方法回顾性分析NICU住院时间超过48h新生儿的临床资料，分析院内感染发生、发展及相关的危险因素。结果该研究中1357例患儿发生院内感染202例次，院内感染发生率为14．89％（202／1375），日感染率为10．44％。（202／19355）。不同出生体重与胎龄患儿院内感染发生率比较有统计学意义，其中出生体重〈1000g患儿院感发生率为75．00％，胎龄〈30周患儿院内感染发生率为52．63％。最常见的院内感染类型是肺炎[43．07％（87／202）]与败血症[26．73％（54／202）]。院内感染患儿比非院内感染患儿住院时间长（中位住院时间：20d与10d）（P〈0．01），住院费用高（中位住院费用：21045．32元与8108．23元）（P〈0．01）。单因素分析结果显示，院内感染患儿与非院内感染患儿在胎龄、出生体重、5minApgar评分、窒息抢救史、感染前抗生素使用、机械通气、中心静脉置管、胸腔闭式引流管、感染前胸腹部手术方面比较差异有显著统计学意义，Logistic回归分析显示，机械通气、中心静脉置管及感染前使用抗生素为院内感染的独立危险因素。结论NICU新生儿院内感染发生率比较高，机械通气、中心静脉置管及感染前使用抗生素为NICU院内感染独立危险因素。

Objective To study the occurrence of nosocomial infection （NI） situation in the neonatal intensive care unit （NICU） of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to October 2013,and analyze risk factors of NI. Methods A retrospective study was per- formed in the NICU, of which all neonates hospitalized over 48 hours were included and the occurrence situation and risk factors of NI were analyzed. Results This study included 1 357 neonates, and 175 neonates developed 202 times NI. The overall incidence of NI was 14. 89% （202/1 357 ） ,and the incidence density was 10.44 per 1 000 NICU patient-days （202/19 355 ）. The lower the birth weight is, or the smaller gestational age is, the higher the NI rate is. The NI rate was 75.00% in neonates whose birth weight 〈 1 000 g,and the NI rate was 52. 63% in neonates whose gestational age 〈 30 weeks. The most common infection type was pneumonia[ 43.07% （87/ 202 ） ] and sepsis [ 26. 73% （54/202） ]. The hospital stay of the NI neonates was longer and the cost of hospitali- zation is higher than non-NI neonates （Median stay：20 days and 10 days. Median cost：21 045.32 yuan and 8 108.23 yuan） （ both P 〈 0.01 ）. Univariate analysis showed there were significant differences between NI neo- nates and non-NI neonates on gestational age,birth weight,5 min Apgar score, asphyxia rescue history ,previons antibiotics use,mechanical ventilation,peripherelly inserted central catheter（ PICC）, closed thoracic drainage tube and chest or abdominal surgery before NI. The logistic regression analysis indicated that previous antibiotics use, mechanical ventilation and PICC were important risk factors for NI. Conclusion The NI rate in NICU is still high. Previous antibiotics use, mechanical ventilation and central venous catheter are risk factors of NI.