新生儿肺透明膜病医院感染的高危因素及控制对策

High risk factors for nosocomial infection in neonates with hyaline membrane disease and control countermeasures

目的探究新生儿肺透明膜病发生医院感染的高危因素以及控制对策。方法选取我院新生儿肺透明膜病患儿324例,分析体重、胎龄、喂养方式、分娩方式、侵入性操作等因素与患儿医院感染的关系,研究病原菌种类,并对高危因素进行logistic回归分析。结果 324例患儿中发生54例院感,感染率16.67%,患儿感染部位以上呼吸道(27.78%)和肺脏(51.85%)为主,培养的54株病原菌中,革兰阳性菌15株,以葡萄球菌属为主(20.37%),革兰阴性菌37株,以肺炎克雷伯杆菌为主(37.04%),真菌2株,为白假丝酵母。多因素logistic回归分析,发现体重<2500g、胎龄<37周、住院时间长、剖宫产分娩、肠外营养、侵入性操作、感染前使用抗菌药物是新生儿院内感染的独立危险因素(P<0.05)。结论:新生儿病房中应重点关注低体重、肠外营养、早产、剖宫产的患儿,通过减少侵入性操作、感染前预防性使用药物能有效控制院感的发生。

OBJECTIVE To explore the high risk factors for nosocomial infection in neonates with hyaline membrane disease and put forward control countermeasures.METHODS A total of 324 neonates with hyaline membrane disease who were treated in the hospital were enrolled in the study.The correlation between the factors such as body weight,gestational age,feeding patterns,delivery mode,invasive procedures and the nosocomial infection was observed,the species of pathogens were identified,and the logistic regression analysis was performed for the high risk factors.RESULTS Of the 324 neonates,54 had nosocomial infection,with the infection rate 16.67%,27.78%of whom had upper respiratory tract infection,and 51.85% had pulmonary infection.Totally 54 strains of pathogens were isolated,15 of which were gram-positive bacteria,37 were gram-negative bacteria,and 2 were fungi.Staphylococcus spp was dominant among the gram-positive bacteria,accounting for 20.37%;Klebsiella pneumoniae was the predominant species of gram-negative bacteria,accounting for 37.04%;Candida albicans was dominant among the fungi.The multivariate logistic regression analysis showed that the body weight les than2500 g,gestational age less than 37 weeks,long length of hospital stay,cesarean section,parenteral nutrition,invasive procedure and use of antibiotics before infection were the independent risk factors for the nosocomial infection in the neonates（P〈0.05）.CONCLUSIONSIt is necessary to attach great importance to the neonates with low body weight,parenteral nutrition,premature delivery and cesarean section,reduce the invasive procedures and carry out antibiotics prophylaxis before the infection so as to effectively control the nosocomial infection.