极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

Incidence of late-onset sepsis in very low birth weight and extremely low birth weight infants and risk factors for late-onset sepsis

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P<0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P<0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。

Objective To investigate the incidence of late-onset sepsis（LOS） in very low birth weight（VLBW） and extremely low birth weight（ELBW） infants in the neonatal intensive care unit（NICU） and the risk factors for LOS.Methods A retrospective analysis was performed for the clinical data of all VLBW and ELBW infants who were hospitalized in the NICU between January 2011 and December 2013.According to the presence or absence of LOS,these infants were divided into LOS group and non-LOS group.The incidence and mortality rates of LOS,common pathogenic bacteria,and risk factors for LOS were analyzed.Results Of the 226 VLBW and ELBW infants,117（51.8%） developed LOS,among whom 45 had a confirmed diagnosis of LOS and 72 had a clinical diagnosis of LOS.The LOS group had a significantly higher mortality rate than the non-LOS group [13.7%（16/117） vs 4.6%（5/109）;P0.05].Bacterial culture found 51 strains of pathogenic bacteria,among which 32（63%） were Gram-negative bacteria,16（31%） were Gram-positive bacteria,and 3（6%） were fungi.The multivariate logistic regression analysis showed that gestational age,small for gestational age（SGA）,duration of parenteral nutrition,peripherally inserted central catheter（PICC） placement,and mechanical ventilation were independent risk factors for LOS in VLBW and ELBW infants（OR=0.84,1.59,1.34,3.11,and 4.55 respectively;P0.05）.Conclusions LOS has high incidence and mortality rates in VLBW and ELBW infants.Common pathogenic bacteria of LOS are Gram-negative bacteria.Low gestational age,long duration of parenteral nutrition,SGA,PICC placement,and mechanical ventilation may increase the risk of LOS in VLBW and ELBW infants.