早产儿医院获得性晚发败血症病原学及危险因素分析

Analysis of the etiology and risk factors of hospital-acquired late-onset sepsis in premature infants

目的探讨早产儿医院获得性晚发败血症(late-onset sepsis,LOS)的病原菌分布及危险因素。方法回顾性分析2017年4月至2020年4月大理州妇幼保健院收治的82例医院获得性LOS早产儿(观察组)的临床资料,并选取同期未发生败血症的118例早产儿为对照组。分析医院获得性LOS早产儿的病原菌分布,应用Logistic回归分析早产儿医院获得性LOS的危险因素。结果观察组82例患儿共检出89株病原菌,其中革兰阳性菌42株(47.19%),革兰阴性菌39株(43.82%),真菌8株(8.99%)。多因素Logistic回归分析显示,胎龄<32周、出生体重<1500 g、小于胎龄儿、气管插管、中心静脉置管、肠外营养时间≥7 d、使用广谱抗生素、抗生素使用时间≥7 d为早产儿医院获得性LOS的独立危险因素(P<0.05)。结论早产儿医院获得性LOS病原菌以凝固酶阴性葡萄球菌最常见,其次为肺炎克雷伯菌。低胎龄低出生体重、机械通气、中心静脉置管、肠外营养时间及延长抗生素使用时间等可增加早产儿医院获得性LOS的发生风险。

Objective To explore the distribution of pathogenic bacteria and risk factors of hospital-acquired late-onset sepsis(LOS)in premature infants.Methods The clinical data of 82 premature infants with hospital-acquired LOS(observation group)admitted to the Dali Maternal and Child Health Hospital from April 2017 to April 2020 were retrospectively analyzed,and 118 premature infants without sepsis during the same period were selected as the control group.The distribution of pathogenic bacteria in premature infants with hospital-acquired LOS was analyzed,and the risk factors of hospital-acquired LOS in premature infants were analyzed by Logistic regression.Results A total of 89 strains of pathogenic bacteria were detected among 82 children in the observation group,including 42 strains of gram-positive bacteria(47.19%),39 strains of gram-negative bacteria(43.82%),and 8 strains of fungi(8.99%).Multivariate Logistic regression analysis showed that gestational age less than 32 weeks,birth weight less than 1500 g,small for gestation age infants,tracheal intubation,central venous catheterization,parenteral nutrition time more than 7 days,use of broad-spectrum antibiotics and antibiotic use time more than 7 days were independent risk factors for hospital-acquired LOS in premature infants(P<0.05).Conclusion Coagulase-negative staphylococcus is the most common pathogen of hospital-acquired LOS in premature infants,followed by Klebsiella pneumoniae.Low gestational age and low birth weight,mechanical ventilation,central venous catheterization,parenteral nutrition time and prolonged use of antibiotics can increase the risks of hospital-acquired LOS for premature infants.