新生儿肠造瘘手术后医院感染特征及其影响因素

Characteristics and influencing factors of healthcare-associated infection after enterostomy in neonates

目的了解新生儿肠造瘘手术后医院感染情况及其危险因素。方法回顾性收集某院2019年6月—2022年6月新生儿外科病房收治的行肠造瘘手术新生儿的基本资料、临床资料以及术后医院感染发生情况等。根据是否发生医院感染分为医院感染组和非医院感染组,采用单因素分析以及logistic回归分析医院感染的相关危险因素。结果共纳入227例手术新生儿,发生医院感染71例,84例次,医院感染发病率31.28%。感染部位以切口感染(24例次)、胃肠道感染(24例次)和血流感染(23例次)为主,医院感染病例检出49株病原菌,主要为革兰阳性菌(59.18%)。单因素分析显示两组妊娠情况、出生胎龄、出生体重、原发疾病、造瘘位置、造瘘方式、术后使用呼吸机、术后开禁时间比较,差异有统计学意义(均P<0.05);二元logistic多因素回归分析结果显示出生低胎龄[OR=0.806,95%CI(0.676~0.962)]和新生儿坏死性小肠结肠炎(NEC)[OR=0.484,95%CI(0.247~0.948)]是肠造瘘术新生儿手术后发生医院感染的危险因素(均P<0.05)。结论出生低胎龄和NEC是引起肠造瘘术新生儿手术后医院感染的危险因素,临床上应对此类新生儿加以重视。

Objective To evaluate the status and risk factors of healthcare-associated infection(HAI)after ente-rostomy in neonates.Methods Basic information,clinical and postoperative HAI data of neonates underwent ente-rostomy from June 2019 to June 2022 in the department of neonatal surgery of a hospital were collected.Neonates were divided into the HAI group and non-HAI group according to whether HAI occurred after operation.The HAI-related risk factors were analyzed by univariate analysis and logistic regression.Results A total of 227 neonates underwent surgery were analyzed,with 71 neonates having 84 episodes of HAI and a HAI incidence of 31.28%.Infection sites were mainly surgical site infection(n=24),gastrointestinal infection(n=24)and bloodstream infection(n=23).49 pathogenic bacterial strains were detected in HAI cases,mainly Gram-positive bacteria(59.18%).Univariate analysis showed statistically significant differences between two groups in gestational status,gestational age at birth,birth weight,primary disease,fistula location,fistula mode,postoperative ventilator use,and postoperative fasting time(all P<0.05).Binary logistic multivariate regression analysis showed that low gestational age at birth(OR=0.806,95%CI[0.676-0.962])and neonatal necrotizing enterocolitis(NEC)(OR=0.484,95%CI[0.247-0.948])were risk factors for the development of HAI after enterostomy in neonates(both P<0.05).Conclusion Low gestational age at birth and NEC are risk factors for the postoperative HAI in neonates underwent enterostomy.Clinical attention should be paid to these neonates.