新生儿重症监护病房院内感染细菌学变迁及易感因素分析

The analysis of bacteriological changes and susceptible factor of nosocomial infection in neonatal intensive care unit

目的探讨新生儿重症监护病房（NICU）院内感染病原菌变迁及感染危险因素。方法回顾性分析2010年1月至2015年12月NICU中5543例新生儿的临床资料。结果研究期间院内感染率8.75%。院内感染病原菌以表皮葡萄球菌最多，其次为大肠埃希菌及肺炎克雷伯菌。呼吸系统感染占37.73%，血液系统占37.53%。阳性标本中，血液标本所占比例最高36.47%，痰液占32.67%。前三年院内感染病原菌以白假丝酵母菌、肺炎克雷伯菌、表皮葡萄球菌为主；后三年病原菌以表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌肺炎亚种感染最多。出生胎龄<37周（OR=2.29，95%CI：1.89~2.77）、出生体质量<1500g（OR=37.91，95%CI：29.85~48.16）、机械通气（OR=23.16，95%CI：5.72~71.31）、男性（OR=1.24，95%CI：1.03~1.49）、留置尿管（OR=3.73，95%CI：1.94~19.36）为NICU院内感染危险因素。结论新生儿院内感染主要以呼吸及血行感染多见，以表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌感染多见。早产、极低出生体质量儿、机械通气、男性、留置尿管是主要危险因素。

Objetive To explore bacteriological changes and susceptible factor of nosocomial infection in neonatal intensive care unit (NICU). Methods The clinical data from 5543 hospitalized neonates during January 2010 to December 2015 were retrospectively analyzed. Results Nosocomial infection rate during the study period was 8 . 75 %. The most common pathogen of nosocomial infection was Staphylococcus epidermidis, followed by Escherichia coli and Klebsiella pneumoniae. Respiratory infection accounted for 37 . 73 % and blood infection 37 . 53 %. 36 . 74 % blood samples were tested to be positive, and 32 . 67 % sputum were positive. In the first three years, the main pathogens of nosocomial infection were Candida albicans, Klebsiella pneumonia, and Staphylococcus aureus; in the last three years, the main pathogens were Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The susceptible factors of nosocomial infection inNICU were gestational age < 37 week (OR = 2 . 29 , 95 %CI: 1 . 89 - 2 . 77 ), birth body mass < 1500 g (OR = 37 . 91 , 95 %CI:29 . 85 - 48 . 16 ), mechanical ventilation (OR = 23 . 16 , 95 %CI: 5 . 72 - 71 . 31 ), male (OR = 1 . 24 , 95 %CI: 1 . 03 - 1 . 49 ),and indwelling catheter (OR = 3 . 73 , 95 %CI: 1 . 94 - 19 . 36 ). Conclusions Neonatal nosocomial infections mainly were respiratory tract infections and blood infections. Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae were the common pathogens. Premature, very low birth weight, male, indwelling catheter, and mechnical ventilation were the major risk factors.