新生儿重症监护病房器械相关感染流行病学多中心研究

目的了解我国三级甲等综合医院新生儿监护病房(NICU)器械相关感染的流行特点,为预防和控制新生儿器械相关感染提供科学依据。方法以多中心研究的方式,选取全国9个省及直辖市17所医院2013年10月—2014年9月NICU住院新生儿,按照统一的诊断标准和方法,对器械相关感染进行前瞻性监测。结果共监测12 998例NICU住院新生儿,住院总日数为126 125 d,发生13例中央导管相关血流感染(CLABSI)、70例呼吸机相关肺炎(VAP),中央静脉导管使用率为15.56%,CLABSI发病率为0.66‰;呼吸机使用率为7.67%,VAP发病率为7.23‰。≤1 000 g体重组中央静脉导管和呼吸机使用率最高,分别为61.06%和29.91%;床位数20~30张的NICU中央静脉导管使用率(16.67%)最高,呼吸机使用率(4.11%)最低;中央静脉导管和呼吸机使用率均以西南地区最高。不同规模NICU新生儿VAP发病率以床位数20~30张的NICU最低(2.36‰)。不同地区NICU新生儿CLABSI、VAP发病率比较,差异均有统计学意义;CLABSI和VAP发病率均以华南地区最高(分别为2.68‰、31.06‰)、西南地区次之。不同季度NICU新生儿CLABSI、VAP发病率比较,差异均无统计学意义(均P0.05)。结论我国NICU器械使用率及其相关感染率较高,不同出生体重组、不同规模NICU、不同地区存在差异,应继续加强监测,根据感染特点落实防控措施。

Multicenter study on epidemiology of device associated infection in neonatal intensive care units

ObjectiveTo investigate the epidemiological characteristics of device associated infection (DAI) in neonatal intensive care units（NICUs）of tertiary first class hospitals in China, and provide scientific evidence for the prevention and control of neonatal DAI.MethodsNeonates in NICUs at 17 hospitals of 9 provinces from October 2013 to September 2014 were selected for multicenter study, DAI was surveyed prospectively according to the uniform diagnostic criteria and methods.ResultsA total of 12 998 neonates were monitored, the total patient days were 126 125 d, 13 cases of central line associated bloodstream infection (CLABSI) and 70 cases of ventilator associated pneumonia (VAP) occurred, central line utilization rate was 15.56%, incidence of CLABSI was 0.66/1 000 device days; ventilator utilization rate was 7.67%, incidence of VAP was 7.23/1 000 device days. Utilization rates of central line and respirator in neonates with body weight ≤1 000 g was the highest, which were 61.06% and 29.91% respectively; In NICUs with 20 30 beds, utilization rate of central line was the highest(16.67%),and respirator was the lowest(4.11%);of hospitals in different regions, central line and respirator utilization rate in southwest China was the highest. Of different sizes of ICUs, VAP per 1 000 device days was the lowest in NICUs with 20 30 beds(2.36 ‰) . Difference in incidence of CLABSI and VAP per 1 000 device days in neonates at NICUs of different regions were significantly different; incidence of CLABSI and VAP per 1 000 device days was highest in southern China(2.68 ‰ and 31.06‰ respectively),followed by southwest region. Of different quarters, incidence of CLABSI, and VAP per 1 000 device days were not significantly different(all P>0.05).ConclusionDevice utilization rate and incidence of DAI in China are both high, and are different in neonates of different birth weight, at different sizes of NICUs, as well as different regions, monitoring should be intensified, prevention and control measures should be implemented according to infection characteristics.
［Key words］neonatal intensive care unit; central line associated bloodstream infection; ventilator associated pneumonia; epidemiology; multicenter study