新生儿医院感染特点与相关因素的分类树分析

Characteristics and classification tree analysis on related factors of neonatal nosocomial infection

目的了解新生儿医院感染发生的特点,采用分类树模型分析新生儿医院感染的主要危险因素,识别高危人群,为临床采取针对性干预措施提供参考。方法收集2016年6月-2018年11月入住新生儿病房的5 303例患儿的个人信息和临床资料,包括性别、出生体质量、住院时间、器械使用、胃肠外营养和抗生素使用情况进行回顾性分析,了解感染现状,应用分类树模型分析医院感染危险因素。结果观察期间新生儿病房共收治5 303例新生儿,发生医院感染92例,98例次,医院感染率1.73%,感染例次率1.85%;医院感染部位以血液系统为主,占63.27%,以革兰阳性菌感染为主,占59.46%,表皮葡萄球菌是感染的主要病原菌;单因素分析和分类树模型分析结果显示,住院时间、出生体质量、有无使用器械是医院感染的主要危险因素,住院时间≥14d、出生体质量≤1 500g且使用器械的新生儿的医院感染率为27.48%,是医院感染的高危人群。结论低出生体质量、接受器械辅助治疗的新生儿,住院时间长,是新生儿病房医院感染的高危人群,应该被视为重点关注和保护的对象,加强该人群的管理对于减少新生儿医院感染具有重要意义。

OBJECTIVE To study the characteristics of neonatal nosocomial infection, the classification tree model was used to analyze the main risk factors of neonatal nosocomial infection, identify the susceptible groups, and provide references for corresponding clinical intervention measures. METHODS Personal information and clinical data of 5303 neonates admitted from Jun. 2016 to Nov. 2018 were retrospectively analyzed, including gender, birth weight, length of hospital stay, device utilization, parenteral nutrition and antibiotic use, to understand the status of infection, and the classification tree model was used to analyze the risk factors of nosocomial infection. RESULTS During the observation period, 92 patients had 98 cases of nosocomial infection in the 5303 neonates , the infection rate and case rate were 1.73% and 1.85%, respectively. The blood system (63.27 %) and gram-positive bacteria(59.46 %) were the most common infection site and pathogens. Univariate analysis and classification tree model analysis showed that the hospitalization time, birth weight and device utilization were the independent risk factors of neonatal nosocomial infection. The infection rate of neonates with length of hospital stay >14 days, birth weight lower than 1500g and device utilization was 27.48%, and they were the most susceptible individuals. CONCLUSION Neonates with low birth weight, device utilization and long hospitalization time are at high risk of nosocomial infection in neonatal wards. They should be regarded as the focus of attention and protection. Strengthening the management of this population has great significance in reducing nosocomial infection in neonates.