早产儿医院感染危险因素临床分析

目的探讨早产儿医院感染发病的危险因素。方法回顾性分析2009—2012年本院新生儿科收治的早产儿病例资料,选择生后24 h内入院、住院时间>48 h、除外产前细菌感染史的病例,按照是否发生医院感染分为感染组与非感染组,将胎龄<32周、出生体重<1500 g等13项因素视为可疑危险因素,应用卡方检验及多因素非条件逐步Logistic回归分析明确早产儿医院感染的独立危险因素。结果共纳入588例早产儿,感染组259例,非感染组329例,单因素分析结果显示,胎龄<32周,出生体重<1500 g,开奶日龄>5天、机械通气、经外周中心静脉置管、动脉置管、住院时间>2周、预防性应用抗生素8项因素与医院感染相关;进一步Logistic多因素回归分析显示,胎龄<32周(OR=1.731,95%CI 1.054~2.875)、出生体重<1500 g(OR=1.843,95%CI1.052~3.286)及住院时间大于2周(OR=6.445,95%CI 3.883~10.694)为早产儿医院感染的独立危险因素。结论早产儿胎龄越小、出生体重越低、住院时间越长,越易发生医院感染;预防早产儿医院感染的有效措施为加强产前保健,从根本上减少早产儿及低出生体重儿的出生。

Risk factors of nosocomial infection in premature infants

[ Abstract] Objective To investigate risk factors of nosocomial infection in preterm infants. Methods Current retrospective cohort study was conducted from hospital admissions in the neonatal intensive care unit of First Hospital of Jilin University between January 1 st, 2009 and December 31st, 2012. Infants admitted within 24 hours after birth with NICU stay longer than 48 hours, and without prenatal history of bacterial infection were chosen for this study. Recruited infants were divided into two groups with or without infection based on their status of nosocomieal infection during the hospital stay. 13 suspected risk factors were subjected to X2 test and logistic regression analysis to identify independent risk factors that may lead to nosocomial infections. Results Among 588 cases, 259 infants have suffered nosocomial infection during hospital stay. X2 test revealed that the following factors： GA 〈 32 w, BW 〈 1500 g, delayed gastric feeding starting after day 5 of age, mechanical ventilation, PICC line or intra- arterial transcathter placements, time of hospital stay longer than two weeks, and prophylactic antibiotic usage were risk factors for nosocomial infection during hospitalization. Logistic regression analysis further revealed that GA 〈32 w（OR=l. 731,95%CI 1.054-2.875）, BW〈1500 g （OR=1.843,95%CI 1. 052 - 3. 286 ） and duration of hospital stay 〉 2 w （ OR = 6. 445,95% CI 3. 883 - 10. 694 ） were independent risk factors for nosocomial infections. Conclusions GA at the time of birth and birth weight of an infant have a reverse relationship to the risk of development of nosocomial infection; whereas, the length of hospital stay increases the risk of infection. Therefore, improvement of antenatal care to reduce the occurrence of premature and low birth weight birth is the most effective measure to reduce nosocomial infection during hospitalization.