某儿童专科医院住院患儿医院感染特点及危险因素

Characteristics and risk factors of healthcare-associated infection in hospitalized children in a children's hospital

目的了解某儿童专科医院住院患儿医院感染特点及其危险因素,为医院感染的防控提供依据。方法对2013年1月1日—12月31日该儿童专科医院所有住院患儿的临床资料进行回顾性调查分析。结果共调查住院患儿22 458例,其中男性患儿14 494例(64.54%),女性患儿7 964例(35.46%);发生医院感染294例,医院感染率为1.31%(男性患儿1.16%,女性患儿1.58%);医院感染率较高,居前3位的基础疾病是白血病(5.78%)、其他恶性肿瘤(4.01%)和泌尿系统疾病(3.40%);感染部位以上呼吸道(33.22%)、胃肠道(24.67%)和下呼吸道(23.03%)为主。医院感染单因素分析结果显示:年龄≤3岁、住院时间>7 d、入住重症监护病房(ICU)/新生儿重症监护室(NICU)、抢救,以及使用抗菌药物是男女患儿医院感染的危险因素(均P<0.01)。多因素非条件logistic回归分析结果显示:住院时间>7 d、春冬季节患病、有过抢救,以及使用过抗菌药物是男患儿医院感染的独立危险因素;年龄≤3岁、住院时间>7 d、接受过手术/侵入性操作,以及使用过抗菌药物是女患儿医院感染的独立危险因素。结论某儿童专科医院全年医院感染率较低,且存在性别差异,今后可根据患儿不同临床特征建立分级医院感染控制体系。

Objective To understand the characteristics and risk factors of healthcare-associated infection（HAI）in hospitalized children in a children’s hospital,so as to provide reference for prevention and control of HAI. Methods Clinical data of all hospitalized children in this hospital between January 1 and December 31 ,2013 were analyzed retrospectively.Results A total of 22 458 hospitalized children were investigated,14 494（64.54%）were male children,and 7 964（35.46%）were female children;294 cases of HAI occurred,HAI rate was 1 .31 % （male 1 .16%,female 1 .58%）;the top three underlying diseases in children with infection were leukemia（5.78%）,other malignant tumors（4.01 %）,and urinary system diseases（3.40%）;the major infection sites were upper respiratory tract （33.22%）,gastrointestinal tract （24.67%）,and lower respiratory tract （23.03%）.Univariate analysis showed that risk factors for HAI in male and female children were age ≤3 years old,length of hospital stay 〉7 days,stay in intensive care unit/ neonatal intensive care unit,being rescued,and antimicrobial use （all P 〈0.01）.Multivariate non-conditional logistic regression analysis showed that independent risk factors for HAI in male children were length of hospital stay〉7 days,onset of disease in spring and winter season,being rescued,and antimicrobial use;independent risk factors for HAI in female children were age≤3 years old,length of hospital stay〉7 days,underwent surgery/invasive operation,and antimicrobial use.Conclusion HAI rate in the children’s hospital is low,and there are gender differences,HAI control system can be established according to the differentclinical features of children.