早产儿医院感染败血症的危险因素及病原学分析

Risk factors and pathogen distribution in premature infants with nosocomial sepsis

摘要:

目的：探讨早产儿医院感染败血症的主要危险因素和病原菌分布。方法：对2003年1月至2010年12月收治的3418例早产儿进行回顾性分析，对发生医院感染败血症的危险因素进行病例对照研究。结果：早产儿医院感染败血症感染率为3.10%（106/3418），发生感染日龄的中位数为19(4～48) d。感染病原菌中革兰阳性菌占45.2%，以凝固酶阴性葡萄球菌的比例较高（24.3%）；革兰阴性菌占41.7%，以肺炎克雷伯杆菌为主（25.2%）；真菌13.0%。Logistic回归分析提示出生体重、中心静脉置管和肠外营养时间是早产儿院内感染败血症的主要危险因素（OR值分别为3.765、3.051、2.998, 均P<0.05）。结论：早产儿医院感染败血症的主要危险因素是出生体重、中心静脉置管和肠外营养时间；肺炎克雷伯杆菌是早产儿医院感染败血症的主要病原菌。

Abstract:

OBJECTIVE: To investigate the main risk factors and pathogen distribution of nosocomial sepsis among premature infants. METHODS: The clinical data of 3418 hospitalized premature infants from January 2003 to December 2010 were retrospectively analyzed for the risk factors and pathogen distribution of nosocomial sepsis. RESULTS: The incidence of neonatal nosocomial sepsis was 3.10% (106/3418), and the median age at diagnosis of neonatal nosocomial sepsis was 19 (4-48) days. The major pathogens of the infections among these premature infants included gram-positive bacteria (45.2%), especially coagulase-negative Staphylococcus (24.3%), and gram-negative bacteria (41.7%), especially Klebsiella pneumoniae (25.2%), as well as fungus (13.0%). Logistic regression analysis showed that the main risk factors included low birth weight, retention of central venous catheters, and long duration of parenteral nutrition (OR: 3.765, 3.051, and 2.998, respectively; P<0.05). CONCLUSIONS: Low birth weight, retention of central venous catheters, and long duration of parenteral nutrition are the main risk factors for neonatal nosocomial sepsis, whereas the leading pathogen is Klebsiella pneumoniae.