极早产儿医院内感染的病原分布及其危险因素和结局分析

Pathogen distribution,risk factors,and outcomes of nosocomial infection in very premature infants

目的分析我院极早产儿医院内感染的病原分布,探讨其可能的危险因素及不良结局的发生风险。方法回顾性分析2016年1~12月出生,胎龄<32周且出生体重<1500 g的111例极早产儿的临床资料。根据住院≥72 h后是否发生医院内感染分为感染组与未感染组,分析感染组患儿所感染的病原菌及其药敏情况;采用多因素logistic回归分析极早产儿发生医院内感染的潜在危险因素及不良结局的发生风险。结果极早产儿发生医院内感染的主要致病菌为革兰阴性菌,占54%,以铜绿假单胞菌最为常见;其次为真菌(41%),以白色念珠菌最为多见。药敏试验显示:革兰阴性菌对β-内酰胺类及碳青霉烯类均有较高耐药性,对喹诺酮类具有较高敏感性;真菌对伊曲康唑敏感性较低,对5-氟胞嘧啶和两性霉素B具有较高敏感性。早发败血症、外周静脉穿刺中心静脉置管(PICC)时间、激素暴露、肠外营养时间为极早产儿医院内感染的危险因素(P<0.05)。感染组早产儿肺部并发症的发生风险高于未感染组(P<0.05)。与未感染组比较,感染组患儿住院时间延长,住院费用增加(P<0.001)。结论极早产儿医院内感染受多重因素影响,增加其不良预后的发生风险。临床应结合药物敏感分析,采取合理防治措施,改善极早产儿的预后。

Objective To study the pathogen distribution and risk factors of nosocomial infection in very preterm infants,as well as the risk of adverse outcomes.Methods A retrospective analysis was performed for the clinical data of 111 very preterm infants who were born between January and December,2016 and had a gestational age of 32 weeks and a birth weight of 1 500 g.According to the presence or absence of nosocomial infection after 72 hours of hospitalization,the infants were divided into infection group and non-infection group.The infection group was analyzed in terms of pathogenic bacteria which caused infection and their drug sensitivity.A multivariate logistic regression analysis was used to investigate the potential risk factors and risk of adverse outcomes of nosocomial infection in very preterm infants.Results Gram-negative bacteria were the main pathogens for nosocomial infection in very preterm infants and accounted for 54%,among which Pseudomonas aeruginosa was the most common one; the following pathogens were fungi（41%）,among which Candida albicans was the most common one.The drug sensitivity test showed that Gram-negative bacteria were highly resistant to β-lactam and carbapenems and highly sensitive to quinolones,while fungi had low sensitivity to itraconazole and high sensitivity to 5-fluorocytosine and amphotericin B.Early-onset sepsis,duration of peripherally inserted central catheter,steroid exposure,and duration of parenteral nutrition were risk factors for nosocomial infection in very preterm infants（P〈0.05）.Compared with the non-infection group,the infection group had significantly higher risks of pulmonary complications（P〈0.05）,as well as a significantly longer length of hospital stay and a significantly higher hospital cost（P〈0.001）.Conclusions Nosocomial infection in very preterm infants is affected by various factors and may increase the risk of adverse outcomes.In clinical practice,reasonable preventive and treatment measures should be taken with reference to drug sensitivity,in order to improve the prognosis of very premature infants.