新生儿医院肺部感染病原菌及相关因素分析

Etiological characteristics and risk factors of nosocomial pulmonary infection in newborns

目的探讨新生儿医院肺部感染病原菌及相关因素。方法选择医院2016年6月-2017年6月收治的2 829例新生儿为研究对象,对所有新生儿行血培养或气管内分泌物培养,分析新生儿医院肺部感染病原菌特点,分析新生儿临床资料归纳新生儿医院肺部感染的相关因素。结果 2 829例新生儿发生医院肺部感染59例,感染率为2.09%,共培养分离病原菌86株,其中革兰阴性菌62株占72.09%,以肺炎克雷伯菌和铜绿假单胞菌为主;革兰阳性菌24株占27.91%,以金黄色葡萄球菌为主;铜绿假单胞菌、肺炎克雷伯菌对头孢西丁、头孢噻肟具有较强耐药性,而对左氧氟沙星、美罗培南、亚胺培南较敏感;金黄色葡萄球菌对替考拉宁、万古霉素较敏感。出生体质量、胎龄、营养不良、住院时间、分娩方式、非母乳喂养及侵入性操作是新生儿医院肺部感染的相关因素(P<0.05)。结论明确新生儿医院肺部感染的相关因素,有利于临床对该疾病的防范与治疗,具有一定的临床价值。

OBJECTIVE To study etiological characteristics and risk factors of nosocomial pulmonary infection in newborns.METHODS 2829 newborns in our hospital from Jun.2016-Jun.2017 were selected as the research objects.Blood culture or endotracheal culture was performed on all newborns,and the risk factors and etiological characteristics of nosocomial pulmonary infection in neonates were observed and analyzed.RESULTS A total of 59 cases of nosocomial pulmonary infections occurred in 2829 newborns,the infection rate was 2.09%,of which 86 strains of pathogens were isolated.Gram-negative bacteria accounted for 72.09%,which were mainly Klebsiella pneumoniae and Pseudomonas aeruginosa.There were 24 strains of gram-positive bacteria,accounting for27.91%,dominated by Staphylococcus aureus.K pneumoniae and P.aeruginosa had strong resistance to cefoxitin and cefotaxime,but had a good sensitivity to levofloxacin,meropenem and imipenem.S aureus had a strong resistance to mezlocillin,but was relatively sensitive to teicoplanin and vancomycin.Birth weight of less than 2500 g,gestational age of less than 37 weeks,malnutrition,hospitalization for more than 7 days,cesarean section as the mode of delivery,non-breastfeeding and invasive operations were found to be independent risk factors of nosocomial neonatal pulmonary infection（P〈0.05）.CONCLUSIONBy discussing the risk factors of nosocomial pulmonary infection in neonates and clarifying the common pathogenic bacteria and their susceptibility results,it is helpful to prevent and treat the disease in clinic and has a certain clinical value.