新生儿医院感染现状及相关危险因素分析

Current Situation and Analysis of Related Risk Factors for Nosocomial Infections in Neonates

目的:了解新生儿医院感染现状,分析新生儿医院感染的独立危险因素,确定高危人群,指导临床采取相应的防治措施。方法:选取2014年1月—2018年12月某三级甲等综合医院新生儿科发生医院内感染的188例住院患儿为病例组,并选取同期未发生医院内感染的270例患儿为对照组,进行病例对照研究。收集新生儿胎龄、出生体重、住院天数、侵入性操作、产妇分娩方式、医院感染部位、病原菌检出等信息,分析新生儿医院感染的现状,并采用单因素和多因素Logistic回归分析,探究新生儿医院感染的危险因素。结果:观察期间新生儿科发生医院内感染患儿188例、192例次,5年新生儿医院感染率为3.40%,医院感染例次率为3.47%。医院感染部位以血液系统为主,占67.19%。医院感染检出病原菌以革兰氏阴性菌为主,占89.93%,居前三位的病原菌分别为肺炎克雷伯菌、大肠埃希菌和粘质沙雷菌。多因素Logistic回归分析显示,胎龄<37周、住院天数>21d、新生儿使用呼吸机是新生儿医院感染的独立危险因素。结论:预防早产、缩短住院时间、避免或减少使用呼吸机、采取预防呼吸机相关性肺炎的防控措施是降低新生儿院内感染的重要防治策略。

Objective:To understand the current situation of neonatal nosocomial infection,analyze the independent risk factors of neonatal nosocomial infection,determine the high-risk groups,and guide the clinical to take corresponding prevention and control measures.Methods:188 neonates with nosocomial infection in neonatal department of a general hospital from January 2014 to December 2018 were selected as the case group,while 270 neonates without nosocomial infection in the same period were selected as the control group for the case-control study.The information of neonatal gestational age,birth weight,length of hospital stay,invasive operation,delivery mode,site of nosocomial infection and pathogen detection were collected to analyze the current situation of neonatal nosocomial infection,and using univariate and multivariate Logistic regression analysis to explore the risk factors of neonatal nosocomial infection.Results:During the observation period,188 cases and 192 times of nosocomial infection occurred in neonatal department.The incidence of nosocomial infection was 3.40%,and the case incidence of nosocomial infection was 3.47%.The main site of nosocomial infection was blood system,accounting for 67.19%.The main pathogens of nosocomial infection were Gram-negative bacteria,accounting for 89.93%.The top three pathogens were Klebsiella pneumoniae,Escherichia coli and Serratia marcescens.Multivariate Logistic regression analysis showed that gestational age<37 weeks,length of hospital stay>21 days,neonatal ventilator use were independent risk factors of neonatal nosocomial infection.Conclusion:It is suggested that prevention of preterm birth,shortening hospital stay,avoiding or reducing the use of ventilator,and taking prevention and control measures to prevent ventilator-associated pneumonia are important prevention and control strategies to reduce neonatal nosocomial infection.