新生儿重症监护病房中重症肺炎多种菌感染相关因素分析

Risk factors of multiple bacterial infections in NICU neonates with severe pneumonia

目的分析新生儿重症监护病房(NICU)中重症肺炎新生儿多种菌感染危险因素。方法回顾分析2014年1月至2019年5月收入NICU的1057例重症细菌肺炎新生儿的临床资料,分析其多种菌感染的危险因素。结果单因素分析显示,胎龄(<37周)、出生体质量(<2500 g)、发病日龄(<7 d)、羊水污染(Ⅱ、Ⅲ度)、感染类型(医院感染)、住院时间(≥14天)、机械通气、Apagar评分(<7分)、胎膜早破、抗菌药物使用天数(≥10天)、更换抗菌药物(≥3种)、联合使用抗菌药物(≥3种)12个因素是NICU中重症肺炎新生儿多种菌感染的危险因素,差异有统计学意义(P均<0.05)。多因素分析显示,更换抗菌药物(≥3种)、Apagar评分(<7分)、感染类型(医院感染)、机械通气、羊水污染(Ⅱ、Ⅲ度)是NICU中重症肺炎新生儿多种菌感染的独立危险因素(P<0.05)。结论临床应针对主要危险因素采取综合防控措施,减少NICU新生儿重症肺炎多种菌感染。

Objective To analyze the risk factors of multiple bacterial infection in neonates with severe pneumonia in neonatal intensive care unit(NICU).Methods The clinical data of 1057 newborns with severe bacterial pneumonia admitted to the NICU from January 2014 to May 2019 were retrospectively analyzed,and the risk factors for multiple bacterial infections were analyzed.Results Univariate analysis showed that 12 factors including gestational age(<37 weeks),birth weight(<2500 g),onset age(<7 days),infection type(nosocomial infection),hospital stays(≥14 days),mechanical ventilation,Apagar score(<7 points),premature rupture of membranes,days of antibiotics use(≥10 days),changes of antibiotics(≥3)and combined use of antibiotics(≥3)were risk factors for the multiple bacterial infections in neonates with severe pneumonia in NICU,and differences were statistically significant(P<0.05).Multivariate analysis showed that changes of antibiotics(≥3),Apagar score(<7 points),type of infection(nosocomial infection),mechanical ventilation and amniotic fluid contamination(degree II and III)were independent risk factors for the multiple bacterial infections in neonates with severe pneumonia in NICU(P<0.05).Conclusions Comprehensive prevention and control measures should be taken in the clinic for the main risk factors to reduce multiple bacterial infections of neonates with severe pneumonia in NICU.