2017年许昌市中医院儿科重症监护病房空气细菌学和患儿感染危险因素调查

Survey on bacteriological characteristics of air and risk factors of infection in pediatric intensive care unit,Xuchang city traditional Chinese medicine hospital,2017

目的了解儿科重症监护病房空气环境中细菌学特点及患儿发生感染的危险因素。方法选取2017年1～12月许昌市中医院儿科重症监护同一病区收治的448例重症患儿,对其感染发生24 h内进行血、尿、便等标本采集,同时进行空气样本采样以进行病房环境细菌学及感染病原体鉴定,对影响患儿感染危险因素进行Logistic回归分析。结果在448例患儿中,有110例出现新发细菌感染情况,感染率为24.55%,其中上呼吸道感染为24.55%(27例),下呼吸道感染为38.18%(42例),泌尿道感染为17.27%(19例),胃肠道感染为7.27%(8例),其他部位感染为12.73%(14例)(P<0.01)。大间病房细菌菌落总数(479.47±52.27)CFU/m^3多于小间病房(179.72±35.28)CFU/m^3(P<0.01);大间病房的细菌株数(91株)多于小房间细菌株数(48株)(P<0.01)。3月份细菌菌落总数最多,分别为(524.64±57.61)、(204.61±38.34)CFU/m^3;细菌株数分别为98、54株(P<0.01)。5月份细菌菌落总数最低为(438.45±42.34)、(154.17±26.88)CFU/m^3(P<0.01);细菌株数分别为84株、42株(P<0.05)。病区内空气中共鉴定出91种病原菌,G^+球菌占46.15%,G^+杆菌占19.78%。发生医院感染的危险因素是大间病房(OR=3.99,95%CI=1.92～5.41)、气管插管(OR=2.66,95%CI=1.68～2.97)、置留尿管(OR=2.43,95%CI=1.72～2.65)、住院天数长(OR=1.28,95%CI=0.35～1.99)和意识昏迷(OR=1.33,95%CI=1.21～2.72)。结论该院儿科病房空气悬浮菌以G^+球菌致病菌为主,危险因素为大间病房、气管插管、置留尿管、住院>7 d和意识昏迷。

Objective To understand the bacteriological characteristics of the air environment in pediatric intensive care unit and the risk factors of infection amongchildren.Methods A total of 448 severely children admitted to the same ward of pediatric intensive care in Xuchang city hospital of traditional Chinese medicine during January-December 2017 were enrolled.Blood,urine,stool and other specimens were collected within 24 hours after infection,and air samples were taken at the same time.The bacteriology of the ward and the identification of infectious pathogens were performed,and Logistic regression analysis was performed on the risk factors affecting the infection of children.Results Among the 448 children,110 had new bacterial infections,the infection rate was 24.55%,of which upper respiratory tract infection was 24.55%(27 cases),lower respiratory tract infection was 38.18%(42 cases),urinary tract infection was 17.27%(19 cases),gastrointestinal infection was 7.27%(8 cases),and other sites were 12.73%(14 cases)(P<0.05).The total number of bacterial colonies in the large ward(479.47±52.27)was higher than that in the small ward(179.47±35.28)CFU/m^3(P<0.05);the number of fine strains in the large ward(91 strains)was higher than that in the small room(48 strains)(P<0.05).The total number of bacterial colonies was the highest in March,(524.64±57.61)and(204.61±38.34)CFU/m^3 respectively;the number of fine strains was 98 and 54 respectively(P<0.05).The lowest bacterial colonies occurred in May,which were(438.45±42.34)and(154.17±26.88)CFU/m^3(P<0.05);the number of bacterial strains was 84 and 42(P<0.05).A total of 91 pathogens were identified in the air,G^+cocci accounted for 46.15%,and G^+bacilli accounted for 19.78%.The risk factors for nosocomial infection were large ward(OR=3.99,95%CI=1.92-5.41),tracheal intubation(OR=2.66,95%CI=1.68-2.97),and retention catheter(OR=2.43,95%CI=1.72-2.65),long hospital stay(OR=1.28,95%CI=0.35-1.99)and consciousness coma(OR=1.33,95%CI=1.21-2.72).Conclusion The airborne bacteria in the pediatric ward of the hospital are mainly G^+cocci pathogenic bacteria.The risk factors are large ward,tracheal intubation,retention catheter,hospital stay>7 d and consciousness coma.