Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes

Background: The aim of this study was to determine the tube‐related complications and feeding outcomes of infants discharged home from the neonatal intensive care unit (NICU) with nasogastric (NG) tube feeding or gastrostomy (G‐tube) feeding. Materials and Methods: We performed a chart review of 335 infants discharged from our NICU with home NG tube or G‐tube feeding between January 2009 and December 2013. The primary outcome was the incidence of feeding tube–related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months postdischarge. Univariate and multivariate analyses were conducted. Results: There were 322 infants discharged with home enteral tube feeding (NG tube, n = 84; G‐tube, n = 238), with available outpatient data for the 6‐month postdischarge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube‐related complication. The incidence of tube‐related complications requiring an ED visit was significantly higher in the G‐tube group compared with the NG tube group (33.6% vs 9.5%, P < .001). Two patients died due to a G‐tube–related complication. By 6 months postdischarge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared with 19.3% in the G‐tube group (P < .001). Type of feeding tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months postdischarge. Conclusion: Home NG tube feeding is associated with fewer ED visits for tube‐related complications compared with home G‐tube feeding. Some infants could benefit from a trial home NG tube feeding.     

儿童医院医院感染横断面调查

目的了解儿童医院不同科室医院感染现状,为有效防控儿童医院感染提供科学依据。方法采取床旁调查与住院病历调查相结合的方法,对2012—2014年每年某一日的住院患者进行医院感染现状调查,并对3年的调查资料进行统计分析。结果 2012—2014年各年度医院感染现患率分别为6.52%、5.59%、5.85%,差异无统计学意义(χ2=1.02,P=0.60);3年平均医院感染现患率5.98%,各科室平均医院感染现患率比较差异有统计学意义(χ2=291.83,P0.001),医院感染现患率居前4位的科室为血液内科(27.49%)、心胸外科(21.13%)、新生儿重症监护室(NICU,16.43%)、儿科重症监护室(PICU,12.76%);主要感染部位依次为下呼吸道(58.44%)、上呼吸道(22.63%)、胃肠道(6.58%);在检出的医院感染病原菌构成中,排在首位的是肺炎克雷伯菌(32株,占28.32%),其次为鲍曼不动杆菌和大肠埃希菌(各9株,各占7.96%),铜绿假单胞菌(7株,占6.19%)。结论重点加强医院感染高危科室的防控干预对降低儿童医院感染率具有重要意义。     

Determination of a practical pH cutoff level for reliable confirmation of nasogastric tube placement

Background: Enteral feeding is a common method of nutrition support when oral intake is inadequate. Confirmation of correct nasogastric (NG) tube placement is essential. Risks of morbidity/mortality associated with misplacement in the lung are well documented. Studies indicate that pH ≤4 confirms gastric aspirate, but in pediatrics, a pH of gastric aspirate is often >4. The goal of this study was to determine a reliable and practical pH value to confirm NG tube placement, without increasing the risk of not identifying a misplaced NG tube. Methods: Pediatric inpatients older than 4 weeks receiving enteral nutrition (nasogastric or gastrostomy) were recruited over 9 months. Aspirate samples were pH tested at NG tube placement and before feedings. If pH >4, NG tube position was confirmed by chest radiograph or further investigations. In addition, intensive care unit (ICU) patients who required endotracheal suctioning were recruited, and endotracheal aspirate samples were pH tested. Results: A total of 4,330 gastric aspirate samples (96% nasogastric) were collected from 645 patients with a median (interquartile range [IQR]) age of 1.0 years (0.3–5.2 years). The mean (standard deviation [SD]) pH of these gastric samples was 3.6 (1.4) (range, 0–9). pH was >4 in 1,339 (30.9%) gastric aspirate samples, and of these, 244 were radiographed, which identified 10 misplaced tubes (1 with pH 5.5). A total of 65 endotracheal aspirate samples were collected from 19 ICU patients with a median (IQR) age of 0.6 years (0.4–5.2 years). The mean (SD) pH of these samples was 8.4 (0.8) (range, 6–9.5). Conclusion: Given that the lowest pH value of endotracheal aspirate sample was 6, and a misplaced NG tube was identified with pH 5.5, it is proposed that a gastric aspirate pH ≤5 is a safer, reliable, and practical cutoff in this population.     

Magnetic Resonance–Guided Nasogastric Feeding Tube Placement for Neonates: A Preclinical Study

Background: Establishing postnatal nutrition delivery is challenging in neonates with immature sucking and swallowing ability. Enteral feeding is the gold standard for such patients, but their small size and fragility present challenges in nasogastric (NG) feeding tube placement. Feeding tubes are typically placed with x‐ray guidance, which provides minimal soft tissue contrast and exposes the baby to ionizing radiation. This research investigates magnetic resonance (MR) guidance of NG feeding tube placement in neonates to provide improved soft tissue visualization without ionizing radiation. Materials and Methods: A novel feeding tube incorporating 3 solenoid coils for real‐time tracking and guidance in the MR environment was developed. The feeding tube was placed 5 times in a rabbit with conventional x‐ray guidance to assess mechanical stability and function. After x‐ray procedures, the rabbit was transferred to a neonatal MR system, and the tube was placed 5 more times. Results: In procedures guided by x‐ray and MR, the feeding tube provided sufficient mechanical strength and functionality to access the esophagus and stomach of the rabbit. MR imaging provided significantly improved soft tissue contrast versus x‐ray, which aided in proper tube guidance. Moreover, MR guidance allowed for real‐time placement of the tube without the use of ionizing radiation. Conclusions: The feasibility and benefits offered by an MR‐guided approach to NG feeding tube placement were demonstrated. The ability to acquire high‐quality MR images of soft tissue without ionizing radiation and a contrast agent, coupled with accurate 3‐dimensional device tracking, promises to have a powerful impact on future neonatal feeding tube placements.     

Self‐Insertion of a Nasogastric Tube for Home Enteral Nutrition

Background: Enteral tube feeding can be a source of discomfort and reluctance from patients. We evaluated for the first time the tolerability of self‐insertion of a nasogastric (NG) tube for home enteral nutrition (EN). Materials and Methods: All patients requiring enteral tube feeding for chronic diseases were enrolled in a therapeutic patient education (TPE) program at Nancy University Hospital. Results: In our department, between November 2008 and August 2012, 66 patients received EN with an NG tube. Twenty‐nine of 66 had self‐insertion of the NG tube (median age, 44 years), 17 had an anatomical contraindication, and 20 were excluded because of cognitive disability or language barrier or refusal. Twenty‐eight of 29 patients completed the TPE program. One patient died of pancreatic cancer in palliative care during the study. Median follow‐up was 20 months (interquartile range [IQR], 4–31). Median gain weight was 3.1 kg (IQR, 1.8–6.0) (P = .0002). Median duration of self‐insertion of the NG tube was 3 months (IQR, 2–5), and it was well tolerated by all 29 patients. Two patients described minor adverse events: abdominal pain and nausea for 1 patient and epistaxis leading to temporary discontinuation of EN for another patient. A group of 10 consecutive patients previously had a long‐term NG tube for EN. If they had the choice between a self‐inserted NG tube and a long‐term NG tube, all 10 patients reported they would prefer to start again with the self‐inserted NG tube. Conclusion: This pilot study suggests that self‐insertion of an NG tube may be efficacious and well tolerated in patients receiving EN for chronic conditions.     

2014年贵州省医疗机构住院患者医院感染和社区感染现患率调查

目的了解贵州省医疗机构住院患者医院感染与社区感染现状,以及抗菌药物使用情况。方法2014年9月对贵州省174所二级及二级以上医疗机构住院患者感染情况进行横断面调查。结果共调查68 419例住院患者,实查率为99.65%。发生医院感染1 581例、1 684例次,医院感染现患率为2.31％、例次现患率为2.46％,发生社区感染18 571例、19 191例次,社区感染现患率为27.14％、例次现患率为 28.05％;医院感染和社区感染现患率最高的科室分别为综合ICU、儿科非新生儿组。医院感染部位和社区感染部位比较差异有统计学意义（χ2=17 325.44,P＜0.01）;医院感染和社区感染的病原菌均以大肠埃希菌为主。调查日抗菌药物使用率为39.82%,使用率最高的为综合ICU（80.47%）和儿科（76.67%）。用药目的以治疗用药为主［18 386例（67.48%）］,联合用药以单一用药为主［21 672例（79.55%）］。治疗使用抗菌药物者病原菌培养送检率为31.76%。结论此次调查有助于了解贵州省医院感染和社区感染高发科室、高发部位,以及治疗使用抗菌药物患者病原学送检情况,为进一步的预防与控制医院感染提供依据。     

Home Nasogastric Feeds

Background: Home enteral nutrition (HEN) is a safe method for providing nutrition to children with chronic diseases. Advantages of HEN include shorter hospitalizations, lower cost, and decreased risk of malnutrition‐associated complications. Follow‐up after hospital discharge on HEN is limited. The purpose of this study was to look at children discharged on nasogastric (NG) feeds to assess follow‐up feeding status and impact on growth. Methods: A retrospective chart review was conducted of pediatric patients discharged from Mount Sinai Medical Center on NG feeds between January 2010 and March 2013. Results: A total of 87 patients were included. Average age was 1.2 years. The most common diagnoses were congenital heart disease (47%), metabolic disease (17%), neurologic impairment (10%), liver disease (9%), prematurity (8%), and inflammatory bowel disease (6%). At most recent follow‐up, 44 (50.6%) were on full oral feeds, 8 (9.2%) were still on NG feeds, 9 (10.3%) had a gastrostomy tube placed, 9 (10.3%) were deceased, and 17 (19.5%) had transferred care or were lost to follow‐up. Average time to discontinuation of NG feeds was 4.8 months. Change in body mass index from hospital discharge to follow‐up visit 6 to 12 weeks after discharge was statistically significant, from a mean (SD) of 13.78 (2.82) to 14.58 (2.1) (P = .02). Change in weight z score was significant for neurologic impairment (?1.35 to ?0.04; P = .03). Height z score change was significant for prematurity (?3.84 to ?3.34; P = .02). There was no significant change in height or weight z scores for the other diagnoses. Conclusions: NG feeds can help to improve short‐term growth after hospital discharge in children with chronic illnesses.     

Post‐pyloric feeding tube placement in critically ill patients: Extending the scope of practice for Australian dietitians

Aim

To determine whether the placement of a post‐pyloric feeding tube (PPFT) can be taught safely and effectively to a critical care dietitian.

Methods

This is a prospective observational study conducted in an adult intensive care unit (ICU). The intervention consisted of 19 attempts at post‐pyloric intubation by the dietitian. The 10 ‘learning’ attempts were performed by the dietitian under the direction of an experienced (having completed in excess of 50 successful tube placements) user. A subsequent nine ‘consolidation’ attempts were performed under the responsibility of the intensive care consultant on duty. The primary outcome measures were success (i.e. tip of the PPFT being visible in or distal to the duodenum on X‐ray) and time (minutes) to PPFT placement. Patients were observed for adverse events per standard clinical practice.

Results

A total of 19 post‐pyloric tube placements were attempted in 18 patients (52 (23–70) years, ICU admission diagnoses: trauma n = 4; respiratory failure n = 3; and burns, pancreatitis and renal failure n = 2 each). No adverse events occurred. Most (75%) patients were sedated, and mechanically ventilated. Prokinetics were used to assist tube placement in 11% (2/19) of attempts, both of which were successful. Placement of PPFT was successful in 58% (11/19) of attempts. Whilst training, the success rate was 40% (4/10) compared with 78% (7/9) once training was consolidated (P = 0.17). In the successful attempts, the mean time to placement was 11.0 minutes (3.9–27.1 minutes).

Conclusions

A dietitian can be trained to safely and successfully place PPFT in critically ill patients.     

贵州省布依族自治州医院感染现患率与抗菌药物使用情况调查

目的了解贵州省布依族自治州医院感染现状,为医院感染防控措施的制定提供依据。方法采用床旁调查和病历调查相结合的方法,2014年9月10日—10月5日对贵州省布依族地区二级及二级以上医院进行医院感染现患率调查。结果应调查住院病例6 577例,实际调查6 541例,实查率99.45%。其中医院感染120例、127例次,医院感染现患率为1.83%,例次现患率为1.94%。医院感染居前3位的科室依次为综合重症监护病房（26.32%）、神经外科（6.10%）、儿科新生儿组5.13%;感染部位以下呼吸道居首位（39例次,30.71%）,其次为皮肤软组织（24例次,18.90%）,表浅切口（23例次,18.11%）。共检出病原体58株,以革兰阴性菌为主(44株),革兰阳性菌10株,真菌3株。调查日抗菌药物使用率为42.12%,其中治疗用药占64.75%,预防用药占26.83%,预防+治疗用药占8.42%;单一用药占79.53%,二联用药占19.89%,三联及以上用药占0.58%;治疗用药及治疗+预防用药患者细菌培养送检率为13.76%。结论医院感染现患率调查有助于了解医院感染现况,建议加强医院重点科室重点部位医院感染监测,有效降低医院感染的发生。     

A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically ill children

BACKGROUND: The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university-affiliated 12-bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts. METHODS: Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs > or =10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups. RESULTS: Seventy-five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999). CONCLUSIONS: When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used.     

Establishing Early Enteral Nutrition With the Use of Self‐Advancing Postpyloric Feeding Tube in Critically Ill Children

Introduction: Early nutrition support is an integral part of the care of critically ill children. Early enteral nutrition (EN) improves nitrogen balance and prevents bacterial translocation and gut mucosal atrophy. Adequate EN is often not achieved as gastric feeds are not tolerated and placing postpyloric feeding tubes can be difficult. Spontaneous transpyloric passage of standard feeding tubes without endoscopic intervention or use of anesthesia can range from 30%?80%. The authors report on their experience with a 14Fr polyurethane self‐advancing jejunal feeding tube in a pediatric population. These tubes have been used in the adult population with success, but to the authors’ knowledge, there have been no reports of its use in the pediatric age group. Case Series: The authors present 7 critically ill patients 8–19 years old, admitted to the pediatric intensive care unit, in whom prolonged recovery, inability to tolerate gastric feeds, and dependence on ventilator were predicted at the outset. The jejunal feeding tube was successfully placed on first attempt at the bedside in all 7 patients within the first 24 hours without the use of a promotility agent or endoscopic intervention. Nutrition goal achieved within 48 hours of feeding tube placement was reported for each patient. This case series demonstrates that children fed via the small bowel reached their nutrition goal earlier and did not require parenteral nutrition. Conclusion: The self‐advancing jejunal feeding tube can be used effectively to establish early EN in critically ill children.     

Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review

Background

Challenges for bedside placement of small‐bore feeding tube (SBFT) include iatrogenic injury, multiple exposures to x‐rays, and prolonged placement times. In 2011, the study facility began a feeding tube placement team (FTPT) using the CORTRAK system (CS) in the adult intensive care unit (ICU) and medical‐surgical populations. In 2013, a protocol was implemented using the CS to determine final SBFT location.

Methods

Serial retrospective reviews were done of patients with SBFT placement by the FTPT during July 2011–December 2012 and 2015. Measures included pulmonary deviation, tube location, placement agreement beyond chance for CS tracing and confirmation radiography (CR), x‐ray frequency, and placement time intervals.

Results

A total of 6290 SBFT placements were completed for 4239 patients. First‐attempt SBFT locations were 12.78% gastric, 13.39% first through fourth portion of duodenum, and 73.83% ligament of Treitz/jejunum, with zero placements in esophagus or lung. In 2015, staff avoided 68 lung placements by recognizing proximal pulmonary deviation. X‐ray preprotocol vs protocol (mean [SD]: 1.02 [0.15] vs 0.26 [0.44]) resulted in 74% x‐ray reduction and cost avoidance of $346,000. Time intervals (mean [SD]; N = 6290) were 14.90 (12.74) minutes for insertion, 46.04 (13.80) minutes for placement event, and 3.85 (2.23) hours for consult conclusion. Agreement for n = 1692 placements was 85.28%, with k score of 0.622 (95% confidence limit: 0.582, 0.661; P = .0005).

Conclusions

Team management of SBFT placement using the CS optimizes patient safety, standardizes practice, and decreases cost. Using the CS to determine final SBFT location is a safe alternative to CR.     

One‐Step Insertion of Low‐Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy

Background: Standard care for initiation of enteral feeding in children has been pull percutaneous endoscopic gastrostomy (pull‐PEG). As an alternative to pull‐PEG, a 1‐step endoscopic procedure for inserting a low‐profile gastrostomy tube “button” has been developed that allows initial placement of a balloon‐retained device. This report presents outcomes of metrics used to compare button placement with pull‐PEG in a pediatric population. Methods: Data were generated from procedural experiences of surgeons on pediatric patients (n = 374) with a variety of clinical indications for gastrostomy. Study population ages ranged from 6 days to 16 years, while weights were from 2–84 kg. Results: The button was successfully placed by the 1‐step procedure in 98% of the respective study population, and median procedural times were 20 and 15 minutes for button and pull‐PEG placements, respectively. Median times to first feeds were equivalent for the 1‐step procedure and pull‐PEG (6 hours), while times to first nutrition feeds were 12.5 and 10 hours, respectively. Stoma site complications within each study group were similar. Healthy stoma proportions were 65.2% and 73.2% in the 1‐step procedure and pull‐PEG groups, respectively, at first follow‐up. Conclusions: Similar study outcomes between the 1‐step procedure and pull‐PEG groups suggest that the former is a feasible alternative to pull‐PEG for initial tube placement in children. The 1‐step method involves a single procedure and reduces patient exposure to anesthesia, operating room time, and the potential for complications compared with a pull‐PEG requirement for multiple procedures.     

Nosocomial Pseudomonas aeruginosa conjunctivitis in a pediatric hospital

Conjunctivitis accounted for 5% of nosocomial infections occurring in a university-affiliated pediatric hospital between January 1984 and April 1986. Pseudomonas aeruginosa was recovered from the conjunctiva of 30 patients. The primary diseases of these patients were chronic and debilitating. Eighty percent of patients were under 18 months of age although only 30% of admissions are represented in this age group. Seventy percent of cases occurred in pediatric intensive care unit/neonatal intensive care unit patients. Seventy percent of patients who had antecedent nasopharyngeal/endotracheal cultures obtained were colonized with P aeruginosa. All patients except one had one or more of the following interventions prior to the onset of conjunctivitis: tracheostomy, endotracheal tube, oxygen by hood, or suctioning. Two children (7.4%) have residual corneal scars. Improvements in eye care including protection of the eye during suctioning, other respiratory care, and nasogastric tube procedures are warranted.     

Transnasal endoscopic placement of nasoenteric feeding tubes: outcomes and limitations in non-critically ill patients.

Transnasal endoscopic placement of nasoenteric tubes (NETs) has been demonstrated to be useful in the critical care setting, with limited data on its role in non-critically ill patients. The authors collected data on consecutive patients from a non-critical care setting undergoing transnasal endoscopic NET placement. All NETs were endoscopically placed using a standard over-the-guidewire technique, and positions were confirmed with fluoroscopy. Patients were monitored until the removal of NETs or death. Twenty-two patients (median age = 62.5 years, 36.4% female) were referred for postpyloric feeding, with main indications of persistent gastrocutaneous fistula (n = 6), gastroparesis or gastric outlet obstruction (n = 5), duodenal stenosis (n = 6), acute pancreatitis (n = 4), and gastroesophageal reflux after surgery (n = 1). Postpyloric placement of NET was achieved in 19 of 22 (86.3%) patients, with 36.8% tube positions in the jejunum, 47.4% in the distal duodenum, and 15.8% in the second part of the duodenum. NET placement was least successful in cases with duodenal stenosis. NETs remained in situ for a median of 24 days (range, 2-94), with tube dislodgement (n = 3) and clogging (n = 5) as the main complications. NET feeding resulted in complete healing of gastrocutaneous fistulae in 5 of 6 patients and provision of total enteral nutrition in 3 of 4 cases of acute pancreatitis and 9 of 11 cases of gastroparesis or proximal duodenal obstruction. Transnasal endoscopy has a role in the placement of NET in non-critically ill patients requiring postpyloric feeding. However, there are some limitations, particularly in cases with altered duodenal anatomy.     

How to Promote Bedside Placement of the Postpyloric Feeding Tube

Background: The optimal method of achieving fast, safe, and accurate postpyloric tube placement at the bedside remains controversial. This study investigated whether facilitating techniques of bedside placement would improve the rate of successful placement of postpyloric tubes when compared with the standard technique and whether strategies should be confined to adult or pediatric patients. Methods: We searched electronic databases for eligible literatures that compared different methods of postpyloric tube placement, evaluating the successful rate of postpyloric tube placement. Two reviewers reviewed the quality of the studies and performed data extraction independently. Pairwise and network meta‐analyses were performed to integrate the efficacy. Results: Fourteen clinical trials involving 753 patients were included. Pairwise meta‐analyses demonstrated that prokinetic agents (odds ratio [OR], 2.263; 95% confidence interval [CI]: 1.140–4.490; P = .02) were associated with a higher success rate as compared with the standard technique, and gastric air insufflation was associated with a higher success rate as compared with prokinetic agents (OR, 3.462; 95% CI, 1.63–7.346; P = .001) in adult patients. In network analyses, prokinetic agents and gastric air insufflation were also consistently associated with a higher success rate in adult patients. Trend analyses of rank probabilities revealed gastric air insufflation had the cumulative probability of being the most efficacious strategy (78%), especially in adult patients (88%). Conclusions: Gastric air insufflation seems to be clinically better for promoting bedside placement of postpyloric feeding tubes in adults. Clinicians should no longer use prokinetic agents in pediatric patients or patients without impaired motility.     

2016—2020年武汉市医院感染横断面调查结果趋势研究

目的 了解武汉市医疗机构医院感染和社区感染现状,分析医院感染的流行趋势与管理重点。方法 采用病历调查和床旁调查相结合的方法,按照全国医院感染监控管理培训基地制定的全国医院感染横断面调查表进行调查,分析2016、2018、2020年的调查数据。结果 2016、2018、2020年武汉市医院感染现患率分别为2.66%、2.21%、1.85%,社区感染现患率分别为17.81%、17.82%、16.29%,均呈下降趋势(均P<0.05)。医院感染现患率较高的科室为综合重症监护病房(ICU)、血液病科(组)、神经外科、胸外科、儿科新生儿组;社区感染现患率较高的科室为儿科非新生组、呼吸科(组)、感染病科(组)、综合ICU、儿科新生儿组。医院感染、社区感染感染部位均以下呼吸道为主,其中2016、2018、2020年术后下呼吸道医院感染构成比分别为12.85%、18.39%、22.09%。2016、2018、2020年手术部位医院感染现患率分别为0.99%、0.82%、0.69%。医院感染、社区感染病原体均以革兰阴性菌为主。结论 2016、2018、2020年武汉市医疗机构医院感染管理取得了较好...     

2014年广州地区某儿童医院医院感染现患率

目的了解某儿童专科医院2014年医院感染现患情况。方法采用横断面调查的方法,调查广州某儿童医院2014年9月17日所有住院患者医院感染现患情况。结果共调查997例住院患者,发现医院感染30例、32例次,医院感染现患率3.01%、例次现患率3.21%。感染部位主要为上呼吸道（11例次,占34.38%）;感染高发科室以重症监护病房（ICU,3.99%）和儿内科（3.60%）较高;医院感染患者病原学送检率为93.33%,共检出病原体24株,其中病毒、真菌各6株（各占25.00%）,细菌11株（45.83%）,衣原体1株（4.17%）,细菌主要为金黄色葡萄球菌和表皮葡萄球菌（各3株,各占27.27%）。调查当日抗菌药物使用者451例,使用率为45.24%,其中以治疗用药为主（67.41%）,预防用药和治疗+预防用药的比率分别为19.73%和12.86%;82.26%为单一用药,使用治疗性抗菌药物者（含治疗+预防用药）细菌培养送检率82.60%。结论儿童专科医院需加强重点科室、重点部位的医院感染管理,合理规范使用抗菌药物,保障患者安全。     

2014年新疆132所医院医院感染横断面流行病学调查

目的了解新疆地区不同级别医院医院感染及社区感染现状。方法采用床旁调查与病历调查相结合的方法对2014年3月20日新疆二级及以上医院住院患者感染、抗菌药物使用情况及病原学监测信息进行横断面调查。结果实际调查132所医院66 208例住院患者,医院感染现患率1.83%,医院感染例次现患率2.02%;社区感染现患率24.53%,社区感染例次现患率24.83%。三级医院的医院感染现患率(2.58%)高于二级医院(1.44%),而社区感染现患率(17.84%)低于二级医院(28.01%),差异均有统计学意义(均P0.001)。科室分布中重症监护病房(ICU)医院感染现患率(14.91%)最高,社区感染中儿科组感染率较高。呼吸道、手术部位和泌尿道为医院感染常见部位。抗菌药物使用率为31.27%,二级医院抗菌药物使用率(35.95%,15 642例)高于三级医院(22.32%,5 064例),三级医院治疗性使用抗菌药物病原菌送检率(59.40%,2 224例)高于二级医院(53.59%,6 436例),差异均有统计学意义(χ2值分别为1 288.974、38.964,均P0.001)。医院感染病原菌以革兰阴性杆菌为主,前3位依次为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌。结论横断面调查结果能较好地反映新疆不同级别医院的感染现状,提示需加强感染目标微生物的监测与抗菌药物合理使用的管理和评价,关注重点人群及重点部位感染风险管理。     

Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group.

OBJECTIVES: To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children. DESIGN: 6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center. SETTING: 20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units. PARTICIPANTS: All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria. RESULTS: The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%), Candida for 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negative Staphylococcus (CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units. The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% of Staphylococcus aureus and 89% of CNS were methicillin-resistant, and 37.5% of Klebsiella pneumoniae had an extended-spectrum beta-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units. CONCLUSIONS: We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.