早产儿医院感染目标性监测结果及危险因素分析

目的 分析早产儿医院感染现状、特征及相关危险因素。方法 温州市儿童医院新生儿科2011年1月至2012年12月开展医院感染目标性监测,将入住时间〉48 h的早产儿医院感染情况进行分析,并分析其高危因素。结果 研究期间共纳入早产儿563例,总住院日6310天,51例发生医院感染,共61例次,感染率9.1%,8.1例次/1000住院日。呼吸机相关性肺炎感染率17.2%,37.3例/1000呼吸机使用日;脐静脉、外周中心静脉置管血管相关性感染率12.5%,8.7例/1000导管日。早产儿医院感染病原菌主要为革兰阴性菌,占68.0%,其中肺炎克雷伯菌占24.0%,革兰阳性菌占20.0%,真菌占12.0%。多因素Logistic回归分析显示,胎龄小（OR=1.079,95%CI 1.025~1.136）、极低出生体重（OR=1.053,95%CI 1.038~1.069）、机械通气治疗（OR=4.850,95%CI 3.035~7.751）、胃肠外营养时间（OR=3.180,95%CI 2.058~4.915）、中心静脉置管（OR=4.509,95%CI 2.275~8.935）是早产儿发生医院感染的高危因素。结论 早产儿发生医院感染率较高,存在诸多医院感染易感因素,目标监测对采取防控措施有指导意义。

Targeted surveillance and risk factors on preterm infants with nosocomial infections

Objective To improve the understanding of the nosocomial infections in preterm infants, by determining the characteristics and risk factors in order to take more effective control measures. Methods Preterm infants who were admitted for 〉 48 hours to the neonatal unit at The Children＇s Hospital of Wenzhou City between January 2011 and December 2012 were assessed for nosocomial infection and risk factors analyzed. Results A total of 563 cases were studied. Total hospital days were 6310 days, There were 61 episodes of , nosocomial infection in 51 infants. There was an infection rate of 9.1% in preterm infants （8.1 cases/1000 hospital days）. Ventilator-associated pneumonia infection rate was 17.2%. Umbilical vein, and central venous catheter -related infection rate was 13.6% . The main nosocomial pathogens were gram negative bacteria, accounted for 68.0% （mainly Klebsiella pneumoniae 24. 0%） ; gram positive bacteria accounted for 20. 0% and fungal 12.0%. The study found that preterm infants, small for gestational age, very low birth weight, mechanical ventilation, parenteral nutrition duration, central venous catheter were risk factors for the occurrence of nosocomial infections. Conclusions There is a high occurrence of nosocomial infection in preterm infants due to multiple risk factors. These risk factors should be identified in infants at risk of nosocomial infection in order to take more effective prevention and management measures.