2016年,据世界卫生组织统计,全球每天约有1.5万名5岁以下儿童和3000名5~14岁儿童死亡;我国统计数据显示,每年约有20万名5岁以下儿童死亡[1]。研究[2]显示,50%~70%儿童的死亡地点在医院,尤其是医院的儿科重症监护病房[3]。这提示儿童重...2016年,据世界卫生组织统计,全球每天约有1.5万名5岁以下儿童和3000名5~14岁儿童死亡;我国统计数据显示,每年约有20万名5岁以下儿童死亡[1]。研究[2]显示,50%~70%儿童的死亡地点在医院,尤其是医院的儿科重症监护病房[3]。这提示儿童重症监护病房(pediatric intensive care unit,PICU)和新生儿重症监护病房(neonatel intensive care unit,NICU)的医护人员在挽救危重患儿生命的同时也需对其死亡及死亡后其家庭成员的反应做出准备。展开更多
Objectives. -To know nosocomial infections (NI) rates among newborns and hospitalised children according to age and units of hospitalisation, Methods. -In 2001, the Comitétechnique des infections nosocomiales (CT...Objectives. -To know nosocomial infections (NI) rates among newborns and hospitalised children according to age and units of hospitalisation, Methods. -In 2001, the Comitétechnique des infections nosocomiales (CTIN) initiated a one-day prevalence survey on an arranged date. It was conducted by the 5 centres de coordination de lutte contre les infections nosocomiales (C.CLIN). Paediatric data only were analysed dividing them into 2 groups: newborns (NB) up to 28 days old, whether in maternity, neonatology or intensive care units, and children (CH) from 29 days to 18 years old with separate analysis for surgery, cancer units and intermediate care and rehabilitation centres (ICRC). Results. -The survey included 21 596 children under 18 years old: 9136 NB and 12,460 CH, i.e. 7.1%of the total hospital population on that one given day. A total of 2.6%of the patients were infected, with 1.2%of NB and 3.3%of CH. There were 1.09 infections per patient. 456 different microorganisms were responsible for 562 infections, i.e. 81.1%: 18,6%Staphylococcus aureus of which 26.7%were methicillin resistant (MRSA), 21.9%Staphylococcus epidermis, 21.9%enterobacteries, 10.3%Pseudomonas aeruginosa, 4.4%Candida albicans, and 4.2%rotavirus. NB and CH infection factors were studied separately. Selective criteria for hospitalised NB were: gender: male(P < 0.05), level of gravity (P < 0.05), surgery (P < 0.001), catheter (P < 0.01) and hospital type (P < 0.01). For EN, criteria were severity score (P < 0.01), surgery (P < 0.001), catheter (P < 0.01), and hospital type (P < 0.01). The rate for patients hospitalised in cancer units was 13.2%with no significant factors found. The rate of infected patients in intensive care units was 7.8%for NB and 16.2%for CH, with 9.6%neonatal, 30.8%heart condition, 26.3%non-specialised units and 14.2%children units. ICRC infection rate was 4.5%while surgery units had a rate of 1.9%with 2.4%orthopaedic, 0.7%children units, 2.0%non-specialised units and 8.1%neurosurgery. Discussion. -The 2001 NI level showed a significant fall from 3.5%in the 1996 survey (all ages) to 2.4%. However, including newborns from private maternity units into the survey may have partly lowered this level. MRSA levels have also dropped from 46%in 1996 to 27%in 2001. It is difficult to compare international data as definitions vary. Furthermore, it should be possible to separate newborns from older children as well as specifying the type of units involved. Infected patients levels are generally lower in the French surveys, no matter the age group or units studied than in other surveys. Conclusion. -This survey has enabled the monitoring of the children population in maternity units, on a given day, in France. It showed that the rate of NI in the paediatric population seems low compared to previous data or other countries’data. Efforts need to be made in order to lower it further. Incidence surveillance method is preferable to single out which risk factors can be acted upon. Standardized national protocols are offered to maternity units and should soon be available for newborns units as well as older children units.展开更多
目的了解浙江大学医学院附属儿童医院新生儿重症监护室(neonatal intensive care unit,NICU)医院感染发展趋势,为今后儿童专科医院NICU医院感染防控的方向和重点提供参考依据。方法回顾性分析浙江大学医学院附属儿童医院2013年至2017年N...目的了解浙江大学医学院附属儿童医院新生儿重症监护室(neonatal intensive care unit,NICU)医院感染发展趋势,为今后儿童专科医院NICU医院感染防控的方向和重点提供参考依据。方法回顾性分析浙江大学医学院附属儿童医院2013年至2017年NICU医院感染监测资料,采用卡方检验和Cochran-Armitage趋势检验法。结果5年来医院感染率有差异,例次感染率为7.02%~17.55%,日感染率为3.97‰~10.09‰,呈现逐年下降趋势(Z=3.12、3.78,均P<0.01)。感染分布前5位分别为下呼吸道感染[47.79%(281/588)]、败血症[30.78%(181/588)]、呼吸机相关性肺炎[10.54%(62/588)]、导管相关血流感染[4.08%(24/588)]和胃肠道感染[2.89%(17/588)],下呼吸道、胃肠道感染有逐年下降趋势,败血症、神经系统、皮肤黏膜感染占比有上升趋势。病原微生物分布为革兰阴性菌[63.03%(382/606)]、革兰阳性菌[28.22%(171/606)]、真菌[5.28%(32/606)]、病毒[3.47%(21/606)]。革兰阴性菌中肺炎克雷伯菌最常见,革兰阳性菌中表皮葡萄球菌、金黄色葡萄球菌为多,真菌以近平滑假丝酵母菌为主,病毒主要是轮状病毒、合胞病毒。肺炎克雷伯菌、轮状病毒有逐年下降趋势,表皮葡萄球菌、近平滑假丝酵母菌有上升趋势。未检出万古霉素耐药的肠球菌,耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肺炎克雷伯菌的检出率呈逐年下降趋势,产超广谱β-内酰胺酶大肠埃希菌的检出率有上升趋势。结论儿童医院NICU医院感染发生率变化大,易出现感染聚集或暴发;败血症的感染率逐年增高,表皮葡萄球菌、近平滑假丝酵母菌检出率在增加,产超广谱β-内酰胺酶大肠埃希菌有上升趋势,今后在防控上需要引起关注和重视。展开更多
文摘2016年,据世界卫生组织统计,全球每天约有1.5万名5岁以下儿童和3000名5~14岁儿童死亡;我国统计数据显示,每年约有20万名5岁以下儿童死亡[1]。研究[2]显示,50%~70%儿童的死亡地点在医院,尤其是医院的儿科重症监护病房[3]。这提示儿童重症监护病房(pediatric intensive care unit,PICU)和新生儿重症监护病房(neonatel intensive care unit,NICU)的医护人员在挽救危重患儿生命的同时也需对其死亡及死亡后其家庭成员的反应做出准备。
文摘Objectives. -To know nosocomial infections (NI) rates among newborns and hospitalised children according to age and units of hospitalisation, Methods. -In 2001, the Comitétechnique des infections nosocomiales (CTIN) initiated a one-day prevalence survey on an arranged date. It was conducted by the 5 centres de coordination de lutte contre les infections nosocomiales (C.CLIN). Paediatric data only were analysed dividing them into 2 groups: newborns (NB) up to 28 days old, whether in maternity, neonatology or intensive care units, and children (CH) from 29 days to 18 years old with separate analysis for surgery, cancer units and intermediate care and rehabilitation centres (ICRC). Results. -The survey included 21 596 children under 18 years old: 9136 NB and 12,460 CH, i.e. 7.1%of the total hospital population on that one given day. A total of 2.6%of the patients were infected, with 1.2%of NB and 3.3%of CH. There were 1.09 infections per patient. 456 different microorganisms were responsible for 562 infections, i.e. 81.1%: 18,6%Staphylococcus aureus of which 26.7%were methicillin resistant (MRSA), 21.9%Staphylococcus epidermis, 21.9%enterobacteries, 10.3%Pseudomonas aeruginosa, 4.4%Candida albicans, and 4.2%rotavirus. NB and CH infection factors were studied separately. Selective criteria for hospitalised NB were: gender: male(P < 0.05), level of gravity (P < 0.05), surgery (P < 0.001), catheter (P < 0.01) and hospital type (P < 0.01). For EN, criteria were severity score (P < 0.01), surgery (P < 0.001), catheter (P < 0.01), and hospital type (P < 0.01). The rate for patients hospitalised in cancer units was 13.2%with no significant factors found. The rate of infected patients in intensive care units was 7.8%for NB and 16.2%for CH, with 9.6%neonatal, 30.8%heart condition, 26.3%non-specialised units and 14.2%children units. ICRC infection rate was 4.5%while surgery units had a rate of 1.9%with 2.4%orthopaedic, 0.7%children units, 2.0%non-specialised units and 8.1%neurosurgery. Discussion. -The 2001 NI level showed a significant fall from 3.5%in the 1996 survey (all ages) to 2.4%. However, including newborns from private maternity units into the survey may have partly lowered this level. MRSA levels have also dropped from 46%in 1996 to 27%in 2001. It is difficult to compare international data as definitions vary. Furthermore, it should be possible to separate newborns from older children as well as specifying the type of units involved. Infected patients levels are generally lower in the French surveys, no matter the age group or units studied than in other surveys. Conclusion. -This survey has enabled the monitoring of the children population in maternity units, on a given day, in France. It showed that the rate of NI in the paediatric population seems low compared to previous data or other countries’data. Efforts need to be made in order to lower it further. Incidence surveillance method is preferable to single out which risk factors can be acted upon. Standardized national protocols are offered to maternity units and should soon be available for newborns units as well as older children units.
文摘目的了解浙江大学医学院附属儿童医院新生儿重症监护室(neonatal intensive care unit,NICU)医院感染发展趋势,为今后儿童专科医院NICU医院感染防控的方向和重点提供参考依据。方法回顾性分析浙江大学医学院附属儿童医院2013年至2017年NICU医院感染监测资料,采用卡方检验和Cochran-Armitage趋势检验法。结果5年来医院感染率有差异,例次感染率为7.02%~17.55%,日感染率为3.97‰~10.09‰,呈现逐年下降趋势(Z=3.12、3.78,均P<0.01)。感染分布前5位分别为下呼吸道感染[47.79%(281/588)]、败血症[30.78%(181/588)]、呼吸机相关性肺炎[10.54%(62/588)]、导管相关血流感染[4.08%(24/588)]和胃肠道感染[2.89%(17/588)],下呼吸道、胃肠道感染有逐年下降趋势,败血症、神经系统、皮肤黏膜感染占比有上升趋势。病原微生物分布为革兰阴性菌[63.03%(382/606)]、革兰阳性菌[28.22%(171/606)]、真菌[5.28%(32/606)]、病毒[3.47%(21/606)]。革兰阴性菌中肺炎克雷伯菌最常见,革兰阳性菌中表皮葡萄球菌、金黄色葡萄球菌为多,真菌以近平滑假丝酵母菌为主,病毒主要是轮状病毒、合胞病毒。肺炎克雷伯菌、轮状病毒有逐年下降趋势,表皮葡萄球菌、近平滑假丝酵母菌有上升趋势。未检出万古霉素耐药的肠球菌,耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肺炎克雷伯菌的检出率呈逐年下降趋势,产超广谱β-内酰胺酶大肠埃希菌的检出率有上升趋势。结论儿童医院NICU医院感染发生率变化大,易出现感染聚集或暴发;败血症的感染率逐年增高,表皮葡萄球菌、近平滑假丝酵母菌检出率在增加,产超广谱β-内酰胺酶大肠埃希菌有上升趋势,今后在防控上需要引起关注和重视。
