摘要
目的调查哈尔滨医科大学附属第一医院新生儿重症监护病房(NICU)新生儿感染病原菌分布情况,并分析其相关因素。方法采用病例对照研究方法,选取2020年1月至2023年12月本院NICU收治的感染新生儿198例(感染组),按照性别、日龄等因素选择同期未感染新生儿198例(对照组),对感染组新生儿送检的血液、痰液等标本进行病原菌培养、分离、鉴定,分析病原菌分布情况。感染组与对照组组间比较采用χ^(2)检验或t检验。采用单因素和多因素Logistic回归分析筛选NICU新生儿感染的相关因素。结果198例NICU感染新生儿的感染部位主要为气管(51.69%)、血液(13.04%)、尿液(11.11%)。198例NICU感染新生儿共检出病原菌261株(剔除相同部位、相同菌株),包括革兰阴性菌(167株,63.98%)、革兰阳性菌(83株,31.80%)、真菌(11株,4.21%)。感染组与对照组的分娩方式、合并基础疾病、羊水污染、新生儿窒息、机械通气、母乳喂养、肠外营养支持、深静脉置管、联合使用抗菌药物数量、住院时间、胎龄、出生时体质量、抗菌药物持续使用时间比较差异有统计学意义(P<0.05)。分娩方式“剖宫产”(OR=4.111,P=0.001)、合并基础疾病“≥3种”(OR=3.345,P=0.001)、有羊水污染(OR=2.139,P=0.002)、有新生儿窒息(OR=1.975,P=0.000)、有机械通气(OR=2.863,P=0.000)、住院时间“≥14 d”(OR=3.004,P=0.003)与NICU新生儿感染有关。结论临床上应针对分娩方式“剖宫产”、合并基础疾病“≥3种”、有羊水污染、有新生儿窒息、有机械通气、住院时间“≥14 d”的NICU新生儿进行重点监测和干预。
Objective To investigate the distribution of pathogens causing neonatal infections in the neonatal intensive care unit(NICU)at the First Affiliated Hospital of Harbin Medical University and to analyze its related factors.Methods A case⁃control study was conducted to select 198 infected neonates admitted to the NICU of our hospital from January 2020 to December 2023(infection group),and 198 uninfected neonates(control group)admitted during the same period.They were selected based on gender,age,and other factors.Blood,sputum,and other samples from the infected newborns were cultured,isolated,and identified for pathogenic bacteria.The distribution of pathogenic bacteria was then analyzed.The χ^(2) test or t⁃test was used to compare the infection group and the control group.Univariate and multivariate logistic regression analyses were used to screen for factors related to neonatal infection in the NICU.Results The infection sites(composition ratio>10%)of 198 NICU infected newborns were mainly the trachea(51.69%),blood(13.04%),and urine(11.11%).A total of 261 strains of pathogenic bacteria were detected in 198 NICU infected newborns(excluding the same site and strain).There were Gram negative bacteria(167 strains,63.98%),Gram positive bacteria(83 strains,31.80%),and fungi(11 strains,4.21%).Significant differences were found between the infection group and the control group in the mode of delivery,combined underlying diseases,amniotic fluid contamination,neonatal asphyxia,mechanical ventilation,breast feeding,parenteral nutrition support,deep vein catheterization,combined use of antibiotics,length of hospital stay,gestational age,birth weight,and duration of antibiotic use(P<0.05).The delivery method of cesarean section(OR=4.111,P=0.001),underlying diseases of“≥3 types”(OR=3.345,P=0.001),amniotic fluid contamination(OR=2.139,P=0.002),neonatal asphyxia(OR=1.975,P=0.000),mechanical ventilation(OR=2.863,P=0.000),and hospital stay of“≥14 days”(OR=3.004,P=0.003)were associated with neonatal infection in the NICU.Conclusion In clinical practice,it is important to closely monitor and intervene with NICU newborns who have been delivered through cesarean section,have three or more underlying diseases,are exposed to contaminated amniotic fluid,experience neonatal asphyxia,require mechanical ventilation,or have a hospital stay 14 days or longer.
作者
赵莹
段宏崟
王卓
肇颖新
ZHAO Ying;DUAN Hongyin;WANG Zhuo;ZHAO Yingxin(Neonatal Intensive Care Unit,the First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang,China,150077)
出处
《分子诊断与治疗杂志》
2025年第1期75-78,87,共5页
Journal of Molecular Diagnostics and Therapy
基金
黑龙江省教育科学“十三五”规划重点课题(GJB1320185)。
关键词
重症监护病房
新生儿
感染
病原菌
Intensive care unit
Newborns
Infection
Pathogenic bacteria
