新生儿院内感染发生情况的调查及危险因素分析

目的调查新生儿院内感染发生情况并分析其危险因素。方法收集我院新生儿病房2014年3月-2015年2月收治的1044例新生儿作为研究对象展开回顾性分析,明确院内感染患儿的病原菌分布情况及感染部位,对比感染患儿与未感染患儿的相关资料,明确新生儿院内感染的危险因素。结果40例感染患儿中,病原菌分布:革兰阴性菌22例(55.0%)、革兰阳性菌15例(37.5%)、真菌3例(7.5%)。革兰阴性杆菌对阿米卡星及头孢他啶的耐药率均较高,革兰阳性球菌则对阿莫西林与氨苄西林的耐药率高。29例(72.5%)感染部位为呼吸道,其次为血液6例(15.0%)、消化道3例(7.5%)、皮肤2例(5.0%)。胎龄32周、体质量2.5 kg、Apgar评分5分、合并基础疾病、合并新生儿缺氧缺血脑病(HIE)、使用呼吸机、侵入性操作、使用抗菌药物、住院时间超过1周等均为新生儿住院期间的院内感染危险因素,其中使用呼吸机、侵入性操作、使用抗菌药物、体质量2.5 kg为独立危险因素。结论医护人员需加强无菌观念,避免预防性应用抗生素,尽量减少侵入性操作及呼吸机使用,以降低新生儿院内感染率。

Nosocomial Infections in Neonates and Risk Factors

Objective To investigate the incidence and risk factors of nosocomial infections among neonates.MethodsA total of 1044 neonates born in the Obstetrical Department at our hospital between March 2014 and February 2015 were retrospectively studied and analyzed.The distribution of pathogens and infection sites were determined.The related data was compared between neonates with nosocomial infections and those without to determine the risk factors.ResultsAmong the 40 neonates with nosocomial infections,22 cases (55.0％) were due to Gram-negative bacteria,15 cases (37.5％) due to,Gram positive bacteria and 3 cases (7.5％) due to fungus.The drug resistance rate of Gram negative bacteria to amikacin and ceftazidime was higher while that of Gram positive bacteria to amoxicillin and ampicillin was high.The infection site was the respiratory tract in 29 cases (72.5％),followed by blood in 6 cases (15.0％),the digestive tract in 3 cases (7.5％) and the skin in 2 cases (5.0％).Gestational age ＜32 weeks,weight ＜2.5 kg,Apgar score ＜5 points,complications with underlying diseases or with HIE,use of a ventilator,invasive operation,use of antibiotics and hospitalization of over one week were the risk factors of nosocomial infections among neonates.Besides,use of a ventilator,invasive operation,use of antibiotics and weight ＜2.5 kg were independent risk factors.Conclusion Medical personnel need to strengthen their awareness of aseptic conditions,try not to make any preventative use of antibiotics,minimize the use of invasive operation or ventilators so as to reduce the rate of neonatal nosocomial infections.