新生儿重症监护室医院获得性血流感染的高危因素分析

Risk factors for nosocomial bloodstream infections in a neonatal intensive care unit

摘要:

目的：探讨新生儿重症监护室(NICU)中医院获得性血流感染(BSI)的危险因素。方法：对2005年1月至2006年12月入住华盛顿大学医学院圣路易斯儿童医院NICU的所有新生儿临床资料进行回顾性分析。结果：共有1 290例病例符合入选标准。确诊院内获得性BSI 175人次，其中导管相关性BSI(CRBSI)109例，占62.3%。每1 000个住院日的院内BSI发生率为4.22。Logistic 回归分析显示，小胎龄、5 min低Apgar评分、中心静脉置管及置管时间是NICU病人发生院内BSI的4个独立危险因素。而对中心静脉置管婴儿而言，机械通气是BSI的独立危险因素。结论：导管相关性BSI是院内获得性BSI的主要原因，早产、低Apgar评分及置管时间是导致院内获得性BSI的主要危险因素。［中国当代儿科杂志，2010，12（8）：622-624］

Abstract:

OBJECTIVE: To assess the risk factors for nosocomial blood-stream infection (BSI) in a neonatal intensive care unit (NICU). METHODS: Clinical data from the neonates admitted to the NICU in the St. Louis Children’s Hospital in Washington University School of Medicine between January 2005 and December 2006 were retrospectively studied. RESULTS: A total of 1 290 neonates were included. Overall, 175 nosocomial BSIs occurred. Catheter-related BSIs accounted for 62.3% (109 cases). The incidence of nosocomial BSI was 4.22 per 1 000 patient-days. Logistic regression analysis revealed that low gestational age, low Apgar scores at 5 minutes, use of central venous catheter (CVC), and longer CVC use were risk factors for the development of nosocomial BSI. In the subgroup of neonates with CVC, mechanical ventilation was an additional independent risk factor for BSI. CONCLUSIONS: Catheter-related BSI is the major source of nosocomial BSI in the NICU. Prematurity, low Apgar scores at birth and prolonged CVC use are risk factors for the development of BSI.［Chin J Contemp Pediatr, 2010, 12 (8):622-624］