新生儿重症监护病房医院感染流行病学研究

目的调查新生儿重症监护病房(NICU)医院感染的特点,为预防和控制NICU医院感染提供科学依据。方法监测2013年1月—2017年12月某院NICU入住时间48 h的住院新生儿的医院感染发生情况,并分析其医院感染发病特征及病原菌种类。结果 2013年1月—2017年12月NICU共监测新生儿10 551例,发生医院感染257例,270例次;医院感染发病率2.44%,例次医院感染发病率为2.56%,例次日感染发病率为2.31‰。不同性别医院感染发病率比较,差异无统计学意义(P0.05)。不同出生体重、有无气管插管的新生儿医院感染发病率比较,差异均有统计学意义(均P0.001)。不同年份例次医院感染发病率比较,差异有统计学意义(P0.05)。医院感染部位以下呼吸道为主,占65.19%(其中VAP占36.30%);其次是血液(22.22%)。共检出病原菌169株,以革兰阴性菌为主,其中居前3位分别为鲍曼不动杆菌(26.03%)、肺炎克雷伯菌(22.49%)、大肠埃希菌(19.53%)。结论低出生体重及侵入性操作是NICU住院新生儿发生医院感染的危险因素。减少各种侵入性操作,严格掌握各种置管指征,加强产前孕母的宣教与营养指导,将胎儿的出生体重维持在合理范围均是预防NICU住院新生儿医院感染的关键。

Epidemiological study on healthcare-associated infection in neonatal intensive care unit

Objective To investigate the characteristics of healthcare-associated infection(HAI) in neonatal intensive care unit (NICU), and provide scientific basis for the prevention and control of HAI in NICU. Methods The occurrence of HAI in newborns who were hospitalized in NICU for >48 hours from January 2013 to December 2017 was monitored, and characteristics of HAI and types of pathogens were analyzed. Results From January 2013 to December 2017, a total of 10 551 newborns in NICU were monitored, 257 newborns had 270 cases of HAI; incidence and case incidence of HAI were 2.44% and 2.56% respectively, incidence of HAI per 1 000 day was 2.31, There was no significant difference in the incidence of HAI between different genders (P>0.05). Incidence of HAI in newborns with different birth weight as well as with or without tracheal intubation was significantly different (all P<0.001). Case incidences of HAI among different years were significantly different (P<0.05). The main HAI site was lower respiratory tract, accounting for 65.19% (ventilalor-associated pneumonia accounted for 36.30%), followed by blood stream(22.22%). A total of 169 strains of pathogens were isolated, mainly gram-negative bacteria, the top three were Acinetobacter baumannii (26.03%), Klebsiella pneumoniae (22.49%) and Escherichia coli (19.53%). Conclusion Low birth weight and invasive operation are risk factors for HAI in newborns in NICU. Reducing invasive operation, strictly mastering various indications of catheterization, strengthening prenatal education and nutritional guidance, and maintaining fetal birth weight in a reasonable range are the key to prevent HAI in NICU patients.