重症监护病房新生儿医院感染特点及危险因素的相关性分析

Characteristics of nosocomial infections in neonates of intensive care unit and correlative analysis of risk factors

目的观察和分析重症监护病房新生儿医院感染特点和危险因素,旨在把控重症监护病房新生儿医院感染,提高医疗质量。方法选取2012年1月-2016年2月重症监护病房新生儿1 135例,其中感染95例;观察两类患儿体质量、胎龄、分娩方式、羊水污染、静脉营养及机械通气、平均住院时间等一般资料,以及标本来源、采集、感染部位、病原菌分布、医院感染因素、抗菌药物应用时间等特点,分析重症监护病房新生儿医院感染风险因素。结果 95例重症监护病房新生儿医院感染者,肺部感染率71.58%,高于血液、口腔、皮肤、结膜和尿路感染,差异有统计学意义(P<0.05);检出68株病原菌,革兰阴性菌检出率63.24%,高于革兰阳性菌和真菌,其中肺炎克雷伯菌检出率高于其他病原菌,差异有统计学意义(P<0.05);与相对应项比较,体质量(≤1500g)、胎龄(≤30周)、新生儿窒息、静脉营养、机械通气、抗菌药物应用时间(>7d)、侵入性操作频率(>3次)和住院时间(>14d),差异有统计学意义(P<0.05);上述因素均是重症监护病房新生儿医院感染的高危独立危险因素,差异有统计学意义(P<0.05)。结论观察重症监护病房新生儿医院感染特点、筛查高危因素,有助于掌握医院流行病学资料,根据具体情况制定相应预防对策,提高医院感染控制率。

OBJECTIVE To observe the characteristics of nosocomial infections in neonates of intensive care unit （ICU ） and analyze the risk factors so as to control the nosocomial infection in the neonates of ICU and improve the medical quality .METHODS A total of 1135 neonates who were treated in ICU from Jan 2012 to Feb 2016 were en-rolled in the study ,of whom 95 had the infection .The baseline data of the two categories of neonates ,including body weight ,gestational age ,delivery modes ,amniotic fluid pollution ,intravenous nutrition ,mechanical ventila-tion ,and mean hospitalization duration ,were observed ;the characteristics of the infections ,including specimen sources ,sampling ,infection sites ,distribution of pathogens ,factors for nosocomial infections ,and time of use of antibiotics ,were observed as well ;the risk factors for the nosocomial infections in the ICU neonates were ana-lyzed .RESULTS Among the 95 ICU neonates with nosocomial infections ,the incidence rate of pulmonary infection was 71 .58% ,higher than that of blood ,oral ,skin ,conjunctiva ,or urinary tract infection ,and there was signifi-cant difference （P〈0 .05） .Among the 68 strains of isolated pathogens ,the isolation rate of gram-negative bacteria was 63 .24% ,higher than that of the gram-positive bacteria or fungi ,and the isolation rate of K lebsiella pneumon-iae was significantly higher than that of other species of pathogens （P〈0 .05） .Compared with the corresponding indexes ,there was a significant difference in body mass （no more than 1500 g） ,gestational age （no more than 30 weeks） ,neonatal asphyxia ,intravenous nutrition ,mechanical ventilation ,time of use of antibiotics （more than 7 days） ,frequency of invasive operation （more than 3 times） ,or hospitalization duration （more than 14 days） （（P 〈0 .05） .All of the above factors were the high-risk independent risk factors for the nosocomial infections in the ICU neonates （P〈0 .05） .CONCLUSION It is helpful to observe the characteristics of the nosocomial infection in the ICU neonates and screen out the high-risk factors so as to master the epidemiological data of the hospital .It is necessary to put forward the corresponding prevention countermeasures according to the specific situation so as to raise the rate of control of the nosocomial infections .