NICU早产儿PICC相关血流感染的病原学调查及临床研究

Pathogenic Investigation and Clinical Study of PICC-related Bloodstream Infection in Preterm Infants with NICU

目的分析NICU早产儿发生导管相关性血流感染病原菌分布及耐药性,为临床预防控制提供依据。方法方便选取2016年1月—2018年6月高州市人民医院NICU收治225例留置中心静脉导管早产儿为研究对象,对其发生导管相关性血流感染率、病原菌分布及耐药性进行调查,并对其临床资料进行分析。结果225例中心静脉置管患者,发生CRBSI 33例,感染率14.67%,其中革兰氏阴性杆菌23株(69.70%),以肺炎克雷伯氏菌肺炎亚种为主,真菌8株(24.24%),革兰氏阳性球菌2株(6.06%),该研究结果显示,革兰氏阴性杆菌及真菌是CRBSI的主要致病菌,CRBSI组中的男、女占比分别为:57.6%,42.4%,非CRBSI组男、女占比分别为:52.1%,47.9%,差异无统计学意义(P=0.559);出生胎龄:CRBSI组为(31.39±1.499)周,非CRBSI组为(32.07±1.786)周,差异有统计学意义(P=0.040);出生体重(克):CRBSI组为(1 527.88±288.138)g,非CRBSI组为(1 651.77±320.598)g,差异有统计学意义(P=0.039);住院天数:CRBSI组为(41.94±13.238)d,非CRBSI组为(23.84±12.853)d,差异有统计学意义(P=0.010);住院费用:CRBSI组为(65 130.00±25 309.155),元非CRBSI组为(38 843.91±18 719.706)元,差异有统计学意义(P=0.012)。结论NICU早产儿发生导管相关性血流感染病原菌主要为革兰氏阴性杆菌,应当引起医务人员的重视。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in catheter-related bloodstream infection in premature infants of NICU, and to provide evidence for clinical prevention and control. Methods A total of 225 premature infants with indwelling central venous catheters were enrolled in the NICU of Gaozhou People's Hospital from January 2016 to June 2018. The incidence of catheter-related bloodstream infection, pathogen distribution and drug resistance were investigated. And the clinical data was analyzed. Results Of the 225 patients with central venous catheterization, 33 cases had CRBSI, and the infection rate was 14.67%. Among them, 23 strains (69.70%) of Gram-negative bacilli were mainly pneumoniae pneumonia subspecies and 8 fungi (24.24%), 2 strains of Gram-positive cocci (6.06%). The results of this study showed that Gram-negative bacilli and fungi were the main pathogens of CRBSI. The male and female ratios in the CRBSI group were 57.6%, 42.4%, the proportion of male and female in the non-CRBSI group was 52.1%, 47.9%, the difference was not statistically significant(P=0.559);the gestational age: (31.39±1.499)weeks in the CRBSI group and (32.07±1.786)weeks in the non-CRBSI group, the difference was statistically significant(P=0.040);birth weight: CRBSI group was (1 527.88±288.138)g, non-CRBSI group was (1 651.77±320.598)g, the difference was statistically significant(P=0.039);hospitalization days: the CRBSI group was (41.94±13.238)d, and the non-CRBSI group was (23.84±12.853)d. The difference was statistically significant(P=0010). The hospitalization cost was (65 130.00±25 309.155)yuan in the CRBSI group and (38 843.91±18 719.706)yuan in the non-CRBSI group. The difference was statistically significant(P=0.012). Conclusion The pathogens of catheter-related bloodstream infection in premature infants of NICU are mainly Gram-negative bacilli, which should be paid attention to by medical personnel.