新生儿脐部感染危险因素及病原学分析

目的:探讨新生儿脐部感染的危险因素及进行病原学分析,为制定控制新生儿感染措施提供理论依据。方法:采用目标性监测方法,研究新生儿脐部感染情况及病原学,并对脐带结扎位置、脐带残端长度、脐带直径、脱脐时间、脐带贴卫生、手卫生等12项相关危险因素进行单因素和多因素非条件Logistic回归分析。结果:346例新生儿脐部感染39例,感染率11.27%,主要为大肠埃希氏菌、金黄色葡萄球菌、其他肠道杆菌及耐药菌。脐带结扎位置、脐带残端长度、脐带直径、脐带脱落时间、脐带贴卫生、手卫生对脐部感染有影响(P<0.05)。脐带结扎位置、脐带残端长度、脐带直径、脐带贴卫生是脐部感染的独立危险因素。结论:新生儿易发生脐部大肠埃希氏菌、金黄色葡萄球菌感染,脐带结扎位置距脐根<0.5 cm、脐带残端<0.5 cm、保持脐带贴卫生等可预防脐部感染。     

154例新生儿脐部感染原因分析及防护

目的:分析新生儿脐部感染的相关因素,探讨防护措施。方法:对本院产科出生后7d内的新生儿脐部感染临床资料进行回顾性调查分析。结果:本院4年中出生活产新生儿8 173例,医院内获得性脐部感染154例,感染率1.88%,主要病原菌为表皮葡萄球菌、金黄色葡萄球菌及大肠埃杀氏菌等。结论:由于新生儿缺乏抗细菌定植能力,机体防御能力不全为医院易感人群。故对接触护理新生儿的人员应规范培训,保持脐部清洁干燥,注意无菌技术操作,可防新生儿脐部感染发生。     

预防新生儿脐部感染的护理干预探讨

目的探讨护理干预对预防新生儿脐部感染的影响,为其预防治疗提供参考依据。方法将2012年2月-2013年1月519例新生儿随机分为未干预组、常规干预组和护理干预组,每组各173例;常规干预组采用常规方式干预,护理干预组加用洁悠神喷脐,比较细菌定植率及感染情况,数据采用SPPS17.0软件进行处理。结果未干预组脐部有细菌定植162例,细菌定植率为93.65%,常规组脐部有细菌定植159例,细菌定植率为91.91%,两组差异无统计学意义;护理干预组脐部有细菌定植158例,细菌定植率为91.33%,与常规护理组差异无统计学意义;脐部感染率未干预组为16.18%、常规干预组为4.05%、护理干预组为1.16%,差异有统计学意义(P<0.05)。结论明确新生儿脐部感染的具体诱因,并行相应的护理干预,可有效降低脐部感染率。     

新生儿脐部感染的原因分析及护理对策

目的:探讨新生儿脐部感染的原因及护理对策。方法:对我院产科分娩的足月新生儿共2848例中的45例(1.58%)新生儿脐部出现不同程度的感染进行分析。结果:发现脐部感染与脐粗大、脐带结扎位置太高、剪脐不净、脐断端处理及护理不当有关,又加之新生儿抵抗力低,缺乏抗细菌定植能力,个别护理人员对脐部处理重视不够,使细菌经脐部残端侵入繁殖而引起脐炎。结论:正确掌握断脐的方法和技巧,严格执行无菌操作原则,加强脐部的观察、护理和宣教,保持局部清洁干燥,并针对脐端不同临床表现采用不同护理方法,这是避免脐部感染、预防新生儿感染的有效措施。     

新生儿脐带二次结扎加暴露法的临床应用观察

目的探讨新生儿脐带二次结扎加暴露对新生儿脐带的影响及效果。方法将广元市第二人民医院730例新生儿随机分为观察组和对照组,对照组采取传统的气门芯结扎法,观察组在新生儿出生后24~36 h行脐带二次结扎加暴露,观察新生儿脐带脱落时间、脐部感染发生率等指标。结果观察组新生儿脐带脱落时间短于对照组,脐部感染发生率少于对照组(P0.05)。结论新生儿脐带二次结扎加暴露法,能有效缩短脐带脱落时间,减少脐部感染的发生。     

新生儿脐带护理不同方法效果研究

目的:探讨新生儿不同脐带护理方法的效果,得出其临床应用价值.方法:选取2016年1月至2016年12月每个月30例共计360例新生儿作为研究对象,将360例新生儿分为实验组和常规组,每组180例,新生儿出生后2分钟之内用细橡胶管在脐带根部0.1cm结扎,并在0.5cm处剪断脐带.常规组新生儿在首次沐浴后用75％乙醇旋转擦拭脐带断面和脐带轮状周围,并更换无菌护脐帖,以后每次沐浴都用同上方法消毒并更换无菌帖.实验组患者的消毒方法同常规组,但是不用护脐贴包扎,完全暴露脐带部位,以后每次沐浴只消毒直至自然脱落.观察两组新生儿脐带护理效果、脐部感染以及脐带平均脱落时间.结果:观察组新生儿脐带自然脱落的时间为(4.2±2.5)d,明显短于对照组的(6.8±2.3)d,组间差异明显,有统计学意义(p＜0.05).实验组发生脐部感染1例,脐部感染概率为0.56％;对照组发生脐部感染18例,脐部感染概率为10％,组间差异明显,有统计学意义(p＜0.05).结论:针对新生儿采用脐带完全暴露法能够有效保证脐带部位的干燥和透气,促进脐带结痂、干枯、硬化,加快脐带的自然脱落,进而将其脐带炎症感染.     

新生儿脐带护理方法的比较分析

目的探讨新生儿脐带护理的方法。方法选择天津市红桥医院出生的健康足月新生儿200例,2017年9月-2018年8月出生的100例为观察组,2016年9月-2017年8月出生的100例为对照组。两组断脐后消毒,纱布包扎24 h,观察组脐带消毒干燥暴露,对照组脐带消毒后采用护脐带包裹。比较观察两组新生儿脐带残端脱落时间、脐部完全愈合时间、脐部出血、感染情况。结果观察组脐带脱落,完全愈合时间均少于对照组,脐部出血、感染发生率均低于对照组,差异均有统计学意义(P0.05)。结论新生儿出生后,脐带一定要采取正确的护理方法,脐带护理在预防脐带感染的同时,可确保新生儿的生长发育。医务人员应具体问题具体分析,严格选择脐带护理的方法,保持脐部清洁,对预防新生儿脐带感染有重要的临床意义。     

新生儿重症监护病房定植菌筛查临床应用研究

目的掌握新生儿重症监护病房(NICU)患儿细菌定植状况及与医院感染关系,为NICU医院感染预防控制提供证据。方法对照组患儿698例,观察组患儿966例;观察组所有患儿在入院时常规进行痰或咽拭子培养,查定植菌和药物敏感试验;比较两组患儿感染率、感染暴发次数、呼吸机相关性肺炎(VAP)发生率。结果对照组698例患儿中,73例发生医院感染,感染率为10.46%,观察组966例患儿中,58例发生医院感染,感染率为6.00%(P<0.05);对照组、观察组VAP发生率分别为2.29%、0.62%(P<0.01),感染暴发分别为2、0次;观察组送检痰和咽拭子标本966份,703份有细菌定植,定植率为72.77%,检出致病定植菌432份,检出率为61.45%;432例致病菌定植患儿发生医院感染51例,感染率11.81%,占总感染例数的87.93%;无致病菌定植患儿发生医院感染7例,感染率1.31%,占总感染例数的12.07%,差异有统计学意义(χ2=37.76,P<0.01);432株致病定植菌中,革兰阴性杆菌282株,占65.28%,革兰阳性球菌占34.72%。结论定植菌筛查可早期评估新生儿感染风险,实现医院感染防控早发现、早诊断、早治疗、早防护原则。     

预防新生儿脐部感染的护理干预研究

目的分析护理干预对新生儿脐部感染的影响,寻找有效的预防措施。方法选取医院新生儿科2012年1-6月和2013年1-6月共1 376例新生儿为观察对象,2012年1-6月656例新生儿为常规组,2013年1-6月720例新生儿为干预组;常规组无固定的护理人员,按常规操作沐浴后使用75%乙醇进行脐部皮肤消毒;干预组设有经培训固定的护理人员,使用0.3%过氧化氢进行脐部皮肤消毒,同时加强产房、浴室环境卫生消毒和监测,对产妇及家属进行脐部护理宣教和指导,采用SPSS17.0进行统计分析。结果常规组新生儿发生脐部感染27例,感染率4.1%,干预组新生儿发生脐部感染仅2例,感染率0.3%(P<0.05);新生儿脐带在出生后一周内脱落干预组达91.9%、常规组为30.0%,干预组明显高于常规组(P<0.05);新生儿脐带脱落时间干预组为(5.12±3.05)d,显著低于常规组的(8.54±4.21)d,差异有统计学意义(P<0.05)。结论优质的护理干预能够有效地预防新生儿脐部感染;明显降低新生儿脐部感染率,起到有效地预防作用。     

预防新生儿脐部感染的护理干预研究北大核心CSCD

目的分析护理干预对新生儿脐部感染的影响,寻找有效的预防措施。方法选取医院新生儿科2012年1-6月和2013年1-6月共1 376例新生儿为观察对象,2012年1-6月656例新生儿为常规组,2013年1-6月720例新生儿为干预组;常规组无固定的护理人员,按常规操作沐浴后使用75%乙醇进行脐部皮肤消毒;干预组设有经培训固定的护理人员,使用0.3%过氧化氢进行脐部皮肤消毒,同时加强产房、浴室环境卫生消毒和监测,对产妇及家属进行脐部护理宣教和指导,采用SPSS17.0进行统计分析。结果常规组新生儿发生脐部感染27例,感染率4.1%,干预组新生儿发生脐部感染仅2例,感染率0.3%(P<0.05);新生儿脐带在出生后一周内脱落干预组达91.9%、常规组为30.0%,干预组明显高于常规组(P<0.05);新生儿脐带脱落时间干预组为(5.12±3.05)d,显著低于常规组的(8.54±4.21)d,差异有统计学意义(P<0.05)。结论优质的护理干预能够有效地预防新生儿脐部感染;明显降低新生儿脐部感染率,起到有效地预防作用。     

新生儿重症监护患者耐碳青霉烯类肺炎克雷伯菌定植发展为感染的危险因素分析

 目的 探讨新生儿重症监护病房（NICU）患者耐碳青霉烯类肺炎克雷伯菌（CRKP）定植情况及由定植发展为临床感染的危险因素分析。方法 选取某院2017年1月—2018年12月NICU的新生儿为研究对象,自2017年1月开始开展住院新生儿入院后48 h内及住院期间每周进行一次CRKP肛拭子/咽拭子主动筛查,同时进行CRKP感染监测。应用SPSS 23.0统计软件进行数据分析。结果 共有1 230例NICU新生儿进行了主动筛查,110例新生儿CRKP阳性,CRKP定植率8.9%,其中肠道定植率8.1%（97/1 197）,高于上呼吸道（5.2%,49/945）,差异有统计学意义（P=0.008）。胎龄、低出生体重和住院时间延长是CRKP定植的危险因素（均P<0.001）。Diversilab同源性监测发现,CRKP定植发展为临床感染的概率为19.1%（21/110）。机械通气（OR=10.177,95%CI为2.667~38.830,P=0.013）,新生儿营养风险评估高（OR=0.251;95%CI为0.072~0.881,P=0.031）以及新生儿危重评分-Ⅱ（SNAP-Ⅱ）高（OR=8.256,95%CI为6.072~20.881,P=0.025）是CRKP定植新生儿发展为CRKP临床感染的独立危险因素。结论 CRKP定植增加NICU新生儿住院期间CRKP感染的概率,重点关注接受机械通气、营养不良和SNAP-Ⅱ评分高的新生儿,减少CRKP临床感染的发生。     

新生儿皮肤黏膜凝固酶阴性葡萄球菌定植高危因素分析

目的 探讨新生儿凝固酶阴性葡萄球菌(CNS)的定植特点及高危因素.方法 对2015年8月至2016年5月在北京妇产医院新生儿重症监护室(NICU)B病区住院的新生儿进行鼻部、眼部、脐带、直肠拭子培养,每周1次;静脉导管移除后管端培养.获取每一个CNS定植新生儿临床资料,同期培养阴性的新生儿作为对照组,采用多元线性回归方法进行高危因素分析.结果 在712名入住NICU的新生儿中,60例(8.4%)新生儿发现CNS定植,中位数天数为8天(四分位差4~13),最常见的CNS定植部位为鼻咽部(n=24),其次是气管插管(n=12).CNS定植单因素分析显示实验组的出生体重及胎龄明显低于对照组(t值分别为-17.501、-11.518,均P<0.05),实验组小儿导管使用率明显高于对照组(χ2值分别为34.751、28.229、14.101、62.484,均P<0.05),但两组性别、子宫下段剖宫产、入院年龄、脐炎的发生情况比较均无统计学意义(均P>0.05).多元线性回归分析显示孕周(P=0.042)、出生体重(P=0.000)、经皮插入的中心导管(CVC)(P=0.006)、口鼻吸引(P=0.011)、呼吸机辅助呼吸(P=0.050)、全肠外营养(P=0.015)是CNS定植的独立高危因素.结论 早产、低出生体重、呼吸机使用、中心静脉置管是CNS定植的高危因素,而频繁口鼻吸引同样应该引起高度重视.     

Bacterial colonization patterns in neonates transferred from neonatal intensive care units

After an outbreak with Enterobacter cloacae we decided to routinely nurse all neonates in isolation who were transferred from a neonatal intensive care unit (NICU) to the neonatal unit of the Diakonessenhuis until cultures for MRSA and antibiotic-resistant gram-negative bacteria were negative. The goal of this study was to determine (1) the colonization patterns with (antibiotic-resistant) bacteria; (2) whether there is a trend in time and (3) to identify predictors for colonization. Neonates from 2001 till 2006 transferred from a NICU to our neonatal unit were included. Patients were monitored for infections. In total 287 neonates were included. The average birth weight was 1990 g and gestational age 33 weeks and 3 days. Only one patient was colonized with a highly resistant microorganism (HRMO) and no MRSA was isolated. A NICU-stay longer than one week was the only independent risk factor for bacterial colonization. Twenty-six percent of neonates were colonized with bacteria resistant to amoxicillin/clavulanate. Five neonates (1.7%) developed a bacterial infection after transfer, none of them caused by an antibiotic-resistant microorganism present at transfer. No significant trends in time were found. In conclusion, we found a low prevalence of HRMO and a low incidence of bacterial infections in neonates after transfer from a NICU. There was no significant increase in time in the prevalence of colonization with (resistant) bacteria. A NICU-stay longer than a week was an independent predictor for colonization with bacteria. Based on these observations we have ended standard culturing and nursing in isolation of these patients.     

新生儿肠道CRKP定植和继发感染的影响因素

目的 分析新生儿耐碳青霉烯类肺炎克雷伯菌(CRKP)肠道定植与定植后继发感染的影响因素,为制定CRKP感染的防控策略提供依据。方法 选取2021年1月—2022年10月入住某院新生儿病房的新生儿为研究对象,入院后48 h内进行CRKP首次筛查,此外在住院期间每周进行一次耐碳青霉烯类肠杆菌(CRE)肛拭子主动筛查,并监测CRKP菌株感染情况。分析定植组、非定植组和感染组新生儿临床数据。对肠道定植菌及定植后继发感染新生儿临床标本中分离的非重复CRKP菌株进行碳青霉烯酶基因检测与多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)分析。结果 共有1 438例新生儿进行了CRE主动筛查,174例新生儿CRKP阳性,CRKP定植率为12.1%。174例定植新生儿中有35例继发感染,发病率为20.1%。新生儿CRKP肠道定植的独立危险因素为剖宫产(OR=2.050,95%CI:1.200～3.504,P=0.009)、使用头孢菌素类抗生素(OR=1.889,95%CI:1.086～3.288,P=0.024)、鼻胃管喂养(OR=2.317,95%CI:1.155～4.647,P=0.018);保...     

Invasive pneumococcal infection in 5 newborns, 1996-2004

At the Máxima Medisch Centrum in Veldhoven, The Netherlands, neonatal sepsis caused by invasive Streptococcus pneumoniae infection was diagnosed in 5 neonates between 1996 and 2004. This infection is relatively rare and its clinical features are variable, but often particularly severe and fulminant as was the case in 2 of the 5 children, one of whom died and the other was left with serious psychomotor retardation. The other 3 recovered fully. The child who died and one of the children who recovered are described in some detail. They were both prematurely born neonates, a girl and a boy, who presented almost immediately after birth with an early-onset sepsis caused by S. pneumoniae. In both cases neonatal cultures as well as maternal vaginal swabs were positive for S. pneumoniae growth. 2 different patients had other risk factors for peripartal infection. Neonatal pneumococcal infections are most likely transmitted trough the maternal vaginal tract. Maternal vaginal colonization is rare (0.11%), but associated with a high risk of transmission to the newborn. Asymptomatic neonatal colonization was not observed. In light of the likelihood of a high rate of transmission and subsequent infection, peripartal prophylactic antibiotic treatment is advised for all mothers with proven vaginal S. pneumoniae colonization. If this is not given or is not effective, then in contrast with the policy on patients with group B streptococcal colonization, prophylactic antibiotic treatment is advocated for all neonates born to colonized mothers. Amoxicillin is the preferred treatment. In areas of increasing macrolide resistance, erythromycin should only be advised in cases of penicillin allergy.     

新生儿耐碳青霉烯类肠杆菌感染影响因素

目的 探讨新生儿耐碳青霉烯类肠杆菌（CRE）感染的危险因素,为新生儿CRE感染防控和抗菌药物合理使用提供依据。方法 选择武汉儿童医院新生儿病区2016-2018年CRE感染新生儿68例（CRE组）,随机选取同期同病房碳青霉烯类敏感肠杆菌（CSE）感染新生儿50例（CSE组）,进行回顾性病例对照研究,分析CRE感染的危险因素。结果 CRE组新生儿68例,其中肺炎克雷伯菌感染60例（88.24%）,大肠埃希菌感染7例（10.29%）,产酸肺炎克雷伯菌感染1例（1.47%）。CRE组医院感染38例（55.88%）,CSE组医院感染6例（12.00%）,两组比较差异有统计学意义（P<0.05）。两组新生儿均以下呼吸道感染为主。单因素分析显示,小胎龄、低出生体重、新生儿呼吸窘迫综合征、气管插管、机械通气时间、PICC置管、抗菌药物使用时间、抗菌药物使用种类≥ 3种、碳青霉烯类药物使用史、糖皮质激素使用史、住院时间长均为新生儿感染CRE的危险因素。多因素回归分析显示,低出生体重、机械通气日数、碳青霉烯类药物使用史为CRE感染的独立危险因素。结论 新生儿CRE感染以医院感染为主,应针对新生儿CRE感染危险因素制定综合性防控措施,以减少CRE感染的发生和传播。     

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: risk factors for infection and colonization

An outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBLKp) infections in a neonatal intensive care unit (NICU) prompted a prospective investigation of colonization and infection with this pathogen. From August 1, 1997 to May 30, 1999, neonates admitted to the NICU for more than 24 h were screened for ESBLKp acquisition. Neonatal gastrointestinal screening was performed by means of faecal sampling within 48 h of admission and then weekly until discharge. Isolates were typed using pulsed-field gel electrophoresis (PFGE). Time-dependent proportional hazard models were used to identify independent effects of invasive procedures and antimicrobials after controlling for duration of stay at the NICU. During the study period, 464 neonates were admitted and 383 were regularly screened. Infections occurred in 13 (3.4%) neonates and 206 (53.8%) became colonized. Independent risk factors for colonization during the first nine days in the NICU were the antimicrobial combination cephalosporin plus aminoglycoside [hazard rate (HR)=4.60; 95% CI: 1.48-14.31], and each NICU-day was associated with a 26% increase in the hazard rate for colonization (HR=1.26; 95% CI: 1.16-1.37). Previous colonization (HR=5.19; 95% CI: 1.58-17.08) and central vascular catheter use (HR=13.89; 95% CI: 2.71-71.3) were independent risk factors for infection. In an outbreak setting the proportion of neonates colonized with ESBLKp was observed to increase with the duration of stay and antimicrobial use, and once colonized, infants exposed to invasive devices may become infected.     

Staphylococcus aureus still colonizes the untreated neonatal umbilicus.

Two different neonatal umbilical cord treatment regimens were studied prospectively. Although a greater proportion of cords had separated by the seventh day in those babies not treated with topical antiseptics (47% vs. 26%), there was a significant excess (53% vs. 30%) of umbilical colonization by Staphylococcus aureus compared to those neonates whose cords were treated with alcohol wipes and hexachlorophane powder. The main purpose of treating cords is to prevent significant S. aureus colonization, and therefore current proposals to stop antiseptic treatment of umbilical cords should be disregarded.     

Risk factors associated with nosocomial bacteremia in low birth weight neonates. Grady Memorial Hospital, Atlanta

BACKGROUND: Nosocomial bloodstream infections occur frequently in Neonatal Intensive Care Units and are associated with recognized and unrecognized risk factors. Little has been published regarding risk factors for bloodstream infections in low birth weight neonates. OBJECTIVE: To investigate risk factors for bloodstream infection in neonates < 1,500 g admitted at a Neonatal Intensive Care Unit. METHODS: A prospective study was undertaken in low birth weight neonates (< 1,500g) during a 22 months period. Bivariant, and logistic regresion (stepwise procedure) analysis was used to determine the significance association of bloodstream infection and perinatal and nosocomial risk factors. RESULTS: A total of 72 patiens with nosocomial bacteriemia and 147 non bacteriemic patients were studied. Independent risk factors associated with bloodstream infection were birth weight, persistence of umbilical catheter > 7 days and persistence of peripheral arterial catheter > 1 day. CONCLUSIONS: The uses of umbilical catheter > 7 days, peripheral arterial catheter > 1 day and birth weight < 1,500 g were significant determinants of nosocomial bloodstream infection risk. Because of the importance of invasive procedures as a source of nosocomial bloodstream infections, the lines duration needs to be reviewed with the aim of reducing the incidence of blood stream infection.