中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2011年
12期
915-920
,共6页
麦菁芸%董琳%林振浪%陈尚勤
麥菁蕓%董琳%林振浪%陳尚勤
맥정예%동림%림진랑%진상근
婴儿,新生%交叉感染%危险因素%抗药性,多种,细菌
嬰兒,新生%交扠感染%危險因素%抗藥性,多種,細菌
영인,신생%교차감염%위험인소%항약성,다충,세균
Infant,newborn%Cross infection%Risk factors%Drug resistance,multiple,bacterial
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.
目的 通過對新生兒醫院感染病例進行流行病學調查,探討其危險因素,分析病原學,為預防和控製醫院感染提供依據.方法 對我院新生兒病房2007年1月至2009年12月,醫院感染病例的流行病學資料、臨床特點、病原學、細菌耐藥資料進行迴顧性分析和調查.結果 研究期間住院總人數為6347例,髮生醫院感染433例,感染例次數513例,醫院感染率為6.82％,例次感染率8.0％；總住院日73 663 d,日醫院感染率6.96‰;呼吸機相關性肺炎髮病率為28.7‰；導管相關性血流感染髮病率3.5‰.經多元logistic迴歸分析,結果 顯示髮生醫院感染的主要危險因素是胎齡(OR=1.049)、機械通氣(OR=1.810)、臍靜脈置管(OR=1.106)、住院時間(OR=1.081)、胎膜早破(OR=1.433).在醫院感染疾病構成中,以肺炎最多見,共197例次(38.4％)；其中呼吸機相關性肺炎129例次,佔肺炎的65.5％,佔呼吸機使用人數的24.4％；其次為敗血癥124例次(24.2％)和腹瀉病65例次(12.7％).病原以革蘭陰性菌最多見(54.4％),主要為肺炎剋雷伯菌(19.6％)、鮑曼不動桿菌(8.1％)、銅綠假單胞菌(7.2％)、嗜麥芽窄食單胞菌(4.8％)和大腸埃希菌(4.8％).肺炎剋雷伯菌和大腸埃希菌的產超廣譜β-內酰胺酶( ESBLs)率分彆達91.4％和75.0％,對頭孢菌素普遍耐藥；肺炎剋雷伯菌、鮑曼不動桿菌、銅綠假單胞菌對亞胺培南的耐藥率分彆為1.5％、11.1％和41.7％.耐甲氧西林金黃色葡萄毬菌和耐甲氧西林凝固酶陰性葡萄毬菌的檢齣率分彆為28.6％和95.5％.結論 充分瞭解新生兒醫院感染的危險因素,縮短機械通氣和住院時間,儘早拔除中心靜脈置管可降低醫院感染髮病率；革蘭陰性菌是最主要的醫院感染病原,其中腸桿菌和非髮酵菌的多重耐藥現象已相噹嚴重.
목적 통과대신생인의원감염병례진행류행병학조사,탐토기위험인소,분석병원학,위예방화공제의원감염제공의거.방법 대아원신생인병방2007년1월지2009년12월,의원감염병례적류행병학자료、림상특점、병원학、세균내약자료진행회고성분석화조사.결과 연구기간주원총인수위6347례,발생의원감염433례,감염례차수513례,의원감염솔위6.82％,례차감염솔8.0％；총주원일73 663 d,일의원감염솔6.96‰;호흡궤상관성폐염발병솔위28.7‰；도관상관성혈류감염발병솔3.5‰.경다원logistic회귀분석,결과 현시발생의원감염적주요위험인소시태령(OR=1.049)、궤계통기(OR=1.810)、제정맥치관(OR=1.106)、주원시간(OR=1.081)、태막조파(OR=1.433).재의원감염질병구성중,이폐염최다견,공197례차(38.4％)；기중호흡궤상관성폐염129례차,점폐염적65.5％,점호흡궤사용인수적24.4％；기차위패혈증124례차(24.2％)화복사병65례차(12.7％).병원이혁란음성균최다견(54.4％),주요위폐염극뢰백균(19.6％)、포만불동간균(8.1％)、동록가단포균(7.2％)、기맥아착식단포균(4.8％)화대장애희균(4.8％).폐염극뢰백균화대장애희균적산초엄보β-내선알매( ESBLs)솔분별체91.4％화75.0％,대두포균소보편내약；폐염극뢰백균、포만불동간균、동록가단포균대아알배남적내약솔분별위1.5％、11.1％화41.7％.내갑양서림금황색포도구균화내갑양서림응고매음성포도구균적검출솔분별위28.6％화95.5％.결론 충분료해신생인의원감염적위험인소,축단궤계통기화주원시간,진조발제중심정맥치관가강저의원감염발병솔；혁란음성균시최주요적의원감염병원,기중장간균화비발효균적다중내약현상이상당엄중.
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.
