新生儿重症监护室医院内感染的调查

Investigation of nosocomial infection in the neonatal intensive care unit

摘要:

目的：对我院新生儿重症监护室（NICU）医院内感染（简称院感）进行前瞻性研究，分析其危险因素，以指导临床防治，降低NICU院感发生率。方法：2006年2月至2007年1月收入我院NICU住院时间48 h以上的患儿为研究对象，收集其相关资料，计算院感发生率，多因素回归分析调查其危险因素。结果：入选患儿共计1 159例，院感发生共计169例次，发生率为14.58％，日感染率为19.52‰，肺部感染率为7.94％，居首位，其中呼吸机相关性肺炎(VAP)发病率为每1 000个呼吸机使用日48.8；院感致病菌主要为鲍氏不动杆菌、肺炎克雷伯杆菌、凝固酶阴性葡萄球菌、绿脓杆菌。多因素回归分析显示低出生体重（OR 2.130, 95% CI 1.466~3.094 ）、机械通气（OR 7.038，95% CI 3.901~12.698）、胸腔闭式引流(OR 7.004, 95% CI 1.841~26.653 )及布洛芬治疗(OR 2.907, 95% CI 1.303~6.487)是NICU内院感发生的危险因素。结论：肺部感染是我院NICU 最常见的院感；革兰阴性细菌是院感常见病原菌；低出生体重、机械通气、胸腔闭式引流、布洛芬治疗是NICU内院感的独立危险因素。［中国当代儿科杂志，2010，12（2）：81-84］

Abstract:

OBJECTIVE: A perspective study was conducted to describe the epidemiologic profile of nosocomial infection in the neonatal intensive care unit (NICU). METHODS: The newborn infants who were admitted in the NICU for more than 48 hrs were enrolled from February 2006 to January 2007. The clinical data were collected. The rate of nosocomial infection was calculated according to the CDC surveillance system. The risk factors of nosocomial infection were investigated by multivariate regression analysis. RESULTS: A total of 1 159 neonates were recruited. A total of 169 nosocomial infections occurred, with a cumulative rate for nosocomial infection of 14.58%. The incidence of nosocomial infection was 19.52 per 1 000 patient-days. Ninety-two cases of pneumonia, including 38 cases of ventilator-associated pneumonia (VAP), were reported, with a nosocomial infection rate of 7.94%, which was the most common nosocomial infection in the NICU. Among these infants the rate of VAP was 48.8 per 1 000 ventilator days. The major microorganisms isolated from the infected patients were Acinetobacter baumannii, Klebsiella pneumoniae, Coagulase negative staphylococcus, and aeruginosus Bacillus. Birth weight (OR 2.130, 95%CI 1.466-3.094), mechanical ventilation (OR 7.038, 95%CI 3.901-12.698), chest tube drainage (OR 7.004, 95%CI 1.841-26.653) and ibuprofen therapy (OR 2.907, 95% CI 1.303-6.487) were the risk factors for the development of nosocomial infection. CONCLUSIONS: Pulmonary infection is the most common nosocomial infection in the NICU, and the Gram-negative bacillus is the main pathogen. Low birth weight, mechanical ventilation, chest tube drainage and ibuprofen therapy are independent risk factors for nosocomial infection in the NICU.［Chin J Contemp Pediatr, 2010, 12 (2):81-84］