CAJ | 학술논문

目的探讨新生儿重症监护病房超早产儿医院感染的危险因素.方法对2008年1月至2012年12月收住温州育英儿童医院新生儿重症监护病房的超早产儿135例进行回顾性分析,去除住院时间不满48 h的17例,共118例超早产儿纳入研究.对医院感染发生率、感染的临床特点、危险因素等进行分析.结果 118例超早产儿中发生感染78例,感染率为66.10％,感染例次数129次,例次感染率为109.32％.其中,呼吸机相关性肺炎患病率为1.43％ (35/2 452),导管相关性血流感染患病率为0.35％(16/4 613).超早产儿医院感染疾病以肺炎居首位,共74例次,占57.36％ (74/129),其中呼吸机相关性肺炎35例次,占肺炎47.30％;其次为败血症48例次.共检出90株病原菌,以革兰阴性菌为主[74株(82.22％)],其次为革兰阳性菌12株,真菌4株;肺炎克雷伯菌是超早产儿医院感染最常见病原菌,超广谱β内酰胺酶(ESBL)阳性率达90.91％(20/22),对头孢菌素类均耐药.经单因素分析显示,超早产儿医院感染的危险因素为体重、机械通气、脐静脉置管、中心静脉置管、胃肠外营养时间及住院时间.进一步Logistic回归分析提示,住院时间(OR=1.024,P=0.043)及中心静脉置管(OR =6.170,P=0.041)是超早产儿医院感染的独立危险因素.78例医院感染超早产儿中死亡12例,病死率15.38％.结论超早产儿是医院感染的高危人群,充分了解其医院感染的危险因素,缩短机械通气、中心静脉置管时间及住院时间可降低医院感染发生率.
목적 탐토신생인중증감호병방초조산인의원감염적위험인소.방법 대2008년1월지2012년12월수주온주육영인동의원신생인중증감호병방적초조산인135례진행회고성분석,거제주원시간불만48 h적17례,공118례초조산인납입연구.대의원감염발생솔、감염적림상특점、위험인소등진행분석.결과 118례초조산인중발생감염78례,감염솔위66.10％,감염례차수129차,례차감염솔위109.32％.기중,호흡궤상관성폐염환병솔위1.43％ (35/2 452),도관상관성혈류감염환병솔위0.35％(16/4 613).초조산인의원감염질병이폐염거수위,공74례차,점57.36％ (74/129),기중호흡궤상관성폐염35례차,점폐염47.30％;기차위패혈증48례차.공검출90주병원균,이혁란음성균위주[74주(82.22％)],기차위혁란양성균12주,진균4주;폐염극뢰백균시초조산인의원감염최상견병원균,초엄보β내선알매(ESBL)양성솔체90.91％(20/22),대두포균소류균내약.경단인소분석현시,초조산인의원감염적위험인소위체중、궤계통기、제정맥치관、중심정맥치관、위장외영양시간급주원시간.진일보Logistic회귀분석제시,주원시간(OR=1.024,P=0.043)급중심정맥치관(OR =6.170,P=0.041)시초조산인의원감염적독립위험인소.78례의원감염초조산인중사망12례,병사솔15.38％.결론 초조산인시의원감염적고위인군,충분료해기의원감염적위험인소,축단궤계통기、중심정맥치관시간급주원시간가강저의원감염발생솔.
Objective To investigate the incidence of nosocomial infections of extremely premature infants and to explore the risk factors and strategies for infection control.Method There were 118 extremely premature infants who were confirmed to have nosocomial infection in neonatal intensive care unit of the authors' hospital from January 2008 to December 2012.Their data of the infection rate,risk factors and clinical characteristics were retrospectively analyzed.Result During the study,nosocomial infection occurred in 78 extremely premature infants 129 times.The nosocomial infection rate was 66.10％.The rate of ventilator-associated pneumonia (VAP) was 1.43％ (35/2 452).The catheter related blood stream infection (CRBSI) rate was 0.35％ (16/4 613).There were 74 (57.36％) cases of pneumonia,which was the most common nosocomial infection of extremely premature infants.There were 35 cases of VAP,which accounted for 47.30％ of pneumonia.The next was sepsis,48 cases.Seventy-four (74/90,82.22％)strains of isolates were Gram-negative bacteria,which accounted for the highest proportion,followed by Gram-positive (12 strains),fungus (4 strains) ; Klebsiella pneumonia is the most common pathogens of nosocomial infection in extremely premature infants.The isolation rates of Klebsiella pneumonia with positive extended-spectrum beta-lactamases (ESBL) were 90.91％ (20/22),universally resistant to cephalosporins.Single-factor analysis showed that the body weight,mechanical ventilation,umbilical vein catheterization,central venous catheter,parenteral nutrition and hospitalization time were risk factors for nosocomial infections in extremely preterm infants.Logistic regression analysis showed that length of hospitalization (OR =1.024,P =0.043) and central venous catheterization (OR =6.170,P =O.04 1) were independent risk factors of nosocomial infection.Conclusion Extremely preterm infants were at higher risk of nosocomial infection.It is important to identify the high risk factors for nosocomial infections in extremely premature infants.To shorten time for mechanical ventilation,central venous catheterization and hospitalization days would be conducive to reducing the morbidity of nosocomial infection.