新生儿复数菌血流感染相关因素分析

Relevant Factors of Blood Flow Infection Caused by Plural Bacteria in Neonates

目的分析新生儿复数菌血流感染的相关因素,为临床提供参考。方法回顾2012年1月-2020年10月1107例新生儿血流感染患儿临床资料,根据血培养分为复数菌感染组82例与非复数菌感染组1025例,比较两组感染病原菌分布,相关病史资料与实验室检查,对其复数菌感染相关因素进行分析,归纳出影响新生儿复数菌血流感染相关影响因素。结果新生儿复数菌血流感染率7.41%(82/1107),共分离出病原菌1195株,复数菌血流感染分离出真菌构成比较高(P<0.05),在革兰阳性菌中复数菌血流感染分离出金黄色葡萄球菌构成比较高,在革兰阴性菌中复数菌血流感染鲍曼不动杆菌与铜绿假单胞菌构成比较高(P<0.05)。多因素分析显示,出生胎龄(周)、胎膜早破、感染类型(医院感染)、误吸史、NCIS评分、入住NICU、机械通气、更换抗菌药物种数是新生儿复数菌血流感染独立危险因素(P<0.05)。结论减少不必要的入住NICU、侵入性诊疗和频繁更换抗菌药物,防止胎膜早破与误吸,加强医院感染防控,合理使用抗菌药物,关注早产儿与危重患儿救治是减少新生儿复数菌血流感染的主要措施。

Objective To analyze the related factors of blood flow infection of plural bacteria in neonates and provide clinical reference.Methods The clinical data of 1107 neonates with blood flow infection from January 2012 to October 2020 were retrospectively reviewed.According to blood culture,they were divided into of plural bacterial infection group(82 cases)and non-plural bacterial infection group(1025 cases).The distribution of pathogenic bacteria,related medical history and laboratory examination were compared between the two groups.The related factors of plural bacteria infection were analyzed,and the influencing factors of blood flow infection of plural bacteria in neonates were summarized.Results The blood flow infection rate of neonatal plural bacteria was 7.41%(82/1107)and 1195 strains of pathogenic bacteria were separated.The fungi composition of blood flow infection of plural bacteria was higher(P<0.05).Staphylococcus aureus was higher in blood flow infection of plural bacteria among Gram-positive bacteria.Acinetobacter baumannii and Pseudomonas aeruginosa were higher in blood flow infection of plural bacteria among Gram-negative bacteria(P<0.05).Multivariate analysis showed that age at birth(week),premature rupture of membranes,type of infection(nosocomial infection),history of misuse,NCIS score(score),admission to NICU,mechanical ventilation,and the number of antibiotics exchanged were independent risk factors for blood flow infection of plural bacteria in neonates(P<0.05).Conclusion Reducing unnecessary admission to NICU,invasive diagnosis and frequent replacement of antibiotics,preventing premature rupture of membranes and aspiration,strengthening prevention and control of nosocomial infection,rational use of antibiotics,and paying attention to the treatment of premature and critically ill children are the main measures to reduce blood flow infection of plural bacteria in newborns.