早产儿医院感染调查及其危险因素

目的探讨早产儿医院感染情况及其危险因素。方法对某院2009年1月—2010年12月新生儿重症监护室收治的476例早产儿病历资料进行回顾性调查分析。结果 476例早产儿发生医院感染73例,79例次,医院感染率为15.34%,例次感染率为16.60%;医院感染部位以呼吸道居首位(65.82%),其次为皮肤软组织(12.66%)、胃肠道(7.60%)等;感染病原菌中,革兰阴性菌占53.95%,以肺炎克雷伯菌为主,大肠埃希菌和铜绿假单胞菌次之;革兰阳性菌占38.16%,以表皮葡萄球菌为主,其次为肺炎链球菌和金黄色葡萄球菌;真菌占7.89%,以白假丝酵母菌为主。出生体重低、胎龄小、实施侵入性操作、住院时间长、抗菌药物使用时间长、使用肾上腺糖皮质激素的早产儿医院感染率显著升高(P<0.01)。结论早产儿医院感染率较高,感染部位以呼吸道为主,病原菌以革兰阴性菌为主。低出生体重、小胎龄、实施侵入性操作、住院时间长、抗菌药物使用时间长、使用肾上腺糖皮质激素是早产儿发生医院感染的危险因素。

Healthcare associated infection and risk factors in premature infants

Objective To investigate healthcare-associated infection(HAI) and related risk factors in premature infants.Methods Medical records of 476 premature infants who were hospitalized in a neonatal intensive care unit(NICU) from January 2009 to December 2010 were surveyed retrospectively.Results Of 476 premature infants,73 developed 79 episodes of HAI(15.34%),case infection rate was 16.60%;Respiratory tract was the major infection site(65.82%),followed by skin soft tissue(12.66%) and gastrointestinal tract(7.60%);53.95% of pathogens were gram-negative bacteria,the major pathogens were Klebsiella pneumonia,Escherichia coli and Pseudomonas aeruginosa;38.16% of pathogens were gram-positive bacteria,the main pathogens were Staphylococcus epidermidis,Streptococcus pneumonia and Staphylococcus aureus;7.89% of all pathogens were fungi,the main fungi was Candida albicans.HAI rate was high in premature infants with low birth weight,invasive operation,long length of stay in ICU,long time use of antimicrobial agents,and use of glucocorticoid(P<0.01).Conclusion HAI rate is high in premature infants,the major infection site is respiratory tract,the major pathogen is gram-negative bacteria,the related risk factors for HAI are low birth weight,invasive operation,long hospitalization time,long time use of antimicrobial agents and use of glucocorticoid.