摘要
目的 通过对新生儿医院感染病例进行流行病学调查,探讨其危险因素,分析病原学,为预防和控制医院感染提供依据.方法 对我院新生儿病房2007年1月至2009年12月,医院感染病例的流行病学资料、临床特点、病原学、细菌耐药资料进行回顾性分析和调查.结果 研究期间住院总人数为6347例,发生医院感染433例,感染例次数513例,医院感染率为6.82％,例次感染率8.0％；总住院日73 663 d,日医院感染率6.96‰;呼吸机相关性肺炎发病率为28.7‰；导管相关性血流感染发病率3.5‰.经多元logistic回归分析,结果 显示发生医院感染的主要危险因素是胎龄（OR=1.049）、机械通气（OR=1.810）、脐静脉置管（OR=1.106）、住院时间（OR=1.081）、胎膜早破（OR=1.433）.在医院感染疾病构成中,以肺炎最多见,共197例次（38.4％）；其中呼吸机相关性肺炎129例次,占肺炎的65.5％,占呼吸机使用人数的24.4％；其次为败血症124例次（24.2％）和腹泻病65例次（12.7％）.病原以革兰阴性菌最多见（54.4％）,主要为肺炎克雷伯菌（19.6％）、鲍曼不动杆菌（8.1％）、铜绿假单胞菌（7.2％）、嗜麦芽窄食单胞菌（4.8％）和大肠埃希菌（4.8％）.肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶（ ESBLs）率分别达91.4％和75.0％,对头孢菌素普遍耐药；肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌对亚胺培南的耐药率分别为1.5％、11.1％和41.7％.耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为28.6％和95.5％.结论 充分了解新生儿医院感染的危险因素,缩短机械通气和住院时间,尽早拔除中心静脉置管可降低医院感染发病率；革兰阴性菌是最主要的医院感染病原,其中肠杆菌和非发酵菌的多重耐药现象已相当严重.
Objective To investigate the incidence of nosocomial infections of newborn infants in neonates and to explore the risk factors and strategies of infection control.Methods There were 433confirmed cases of nosocomial infection in the neonatal ward of the authors＇ hospital from January 2007 to December 2009.Their data of epidemiological and clinical characteristics,results of etiological examinations and antibiotic resistance were retrospectively analyzed.Results During the study,the number of hospitalizations were 6437.Nosocomial infection occurred in 433 patients 513 times.The overall nosocomial infection rate was 6.82%.The overall hospitalization days were 73 663 and nosocomial infection patient-day rates were 6.96‰.The VAP infection rate was 28.7‰.The CRBSI rate was 3.5‰.Gestational age（ OR =1.049）,mechanical ventilation（ OR =1.810）,umbilical vein catheter（ OR =1.106）,hospitalization days （OR =1.081 ）,premature rupture of membrane（ OR =1.433 ）were the risk factors for the development of nosocomial infection.There were 197 （38.4%） cases of pneumonia,which was the most common nosocomial infection in Neonatal Ward.There were 129 cases of ventilator- associated pneumonia （ VAP）,which accounts for 65.5% of pneumonia and 24.4% of cases treated with ventilator.The next was sepsis,124 cases （24.2% ） and 64 cases of diarrheal disease （ 12.7% ）.One hundred and eighty two （54.4% ）strains of isolates were Gram-negative bacteria,which accounted for the highest proportion.The predominant pathogens of Gram-negative bacteria were Klebsiella pneumoniae （ 19.6% ）,followed by Acinetobactor baumannii （ 8.1% ）,Pseudomonas aeruginosa （ 7.2% ）,Steotrophomonas maltophilia （ 4.8% ） and Escherichia coli （4.8% ）.The isolation rates of Klebsiella pneumoniae and Escherichia coli with positive extended-spectrum beta-lactamases （ESBLs） were 91.4% and 75%,respectively.Those two bacteria were universally resistant to cephalosporins.The rate of resistance to imipenem of Klebsiella pneumoniae,Acinetobactor baumannii and Pseudomonas aeruginosa were 1.5%,11.1% and 41.7%.The isolation rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were 28.6% and 95.5%.Conclusion It is important to identify the high risk factors for nosocomial infections in newborn infants.To shorten time for mechanical ventilation and hospitalization days,removal of the central venous catheter as early as possible would be conducive to reducing the morbidity of nosocomial infection.The main pathogens were Gram-negative bacteria.The multidrug resistance of Enterobacteriaceae and Non-fermenters is serious.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2011年第12期915-920,共6页
Chinese Journal of Pediatrics
关键词
婴儿
新生
交叉感染
危险因素
抗药性
多种
细菌
Infant, newborn
Cross infection
Risk factors
Drug resistance, multiple,bacterial
