新生儿重症监护病房医院感染病原菌分布及相关危险因素分析

Pathogenic bacteria and risk factors of nosocomial infection in neonatal intensive care unit

目的分析新生儿重症监护病房(NICU)的病原学特征,并研究NICU发生医院感染的危险因素。方法回顾性分析2015年8月至2019年8月昆山市第一人民医院发生NICU感染的125例新生儿作为感染组,选取同期未发生感染的新生儿150例作为未感染组,观察细菌种类及其分布情况;采用单因素分析得到具有统计学意义的危险因素,再进行多因素Logistic回归分析NICU医院感染的独立危险因素。结果NICU医院感染的新生儿主要以呼吸道感染为主,其次为尿路感染;标本中培养出125株病原菌中,革兰阳性菌占61.60%,其中金黄色葡萄球菌(22.40%)和凝固酶阴性葡萄球菌(21.60%)为主要致病菌;革兰阴性菌占37.60%,其中大肠埃希菌(14.40%)和肺炎克雷伯菌(11.20%)为主要病原菌;感染组和未感染组新生儿在胎龄、出生时体质量、抗菌药物使用时间、住院时间、Apgar评分、侵袭性操作方面比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,出生时体质量<2500 g、住院时间≥10 d和侵袭性操作是NICU医院感染的独立危险因素(P<0.05)。结论出生时低体质量、住院时间长和实施侵袭性操作在NICU中发生感染的可能性较高;NICU发生感染的新生儿主要以呼吸道感染为主,病原菌种类以革兰阳性菌居多,但多重耐药菌感染以革兰阴性菌为主。

Objective To explore the pathogenic characteristics of neonatal intensive care unit(NICU)and to study the risk factors of nosocomial infection in NICU.Methods The clinical data of 125 neonates with nosocomial infection in the First People's Hospital of Kunshan City from August 2015 to August 2019 were collected and retrospectively analyzed.The 125 neonates with nosocomial infection was chosen as the experimental group,and 150 newborns without infection during the same period were selected as the control group.The species and distribution of bacteria in two groups were observed,single factor analysis was used to obtain statistically significant risk factors,and then logistic regression was used to analyze the independent risk factors of nosocomial infection in NICU.Results Respiratory tract infection was the main infection,followed by urinary tract infection in neonates infected.Among the 125 strains of pathogenic bacteria,Gram-positive bacteria accounted for 61.60%,among which Staphylococcus aureus(22.40%)and coagulase-negative staphylococci(CoNS)(21.60%)were the main pathogenic bacteria.Gram-negative bacteria accounted for 37.60%,among which Escherichia coli(14.40%)and Klebsiella pneumoniae(11.20%)were the main pathogenic bacteria.Single factor analysis showed that there were statistically significant differences in gestational age,birth weight,duration of antimicrobial use,length of hospital stay,Apgar score,and invasive operation.A multiple logistic regression showed that birth weight<2500 g,length of hospital stay≥10 d and invasive operation were independent risk factors for NICU nosocomial infection(all P<0.05).Conclusion Low birth weight,long hospital stays,and invasive operation are associated with a higher risk of infection in the NICU.The infection of neonates in NICU is mainly caused by respiratory tract infection,and most of the pathogenic bacteria were Gram-positive bacteria,while Gram-negative bacteria were mainly caused by multi-drug resistant bacteria.