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目的探讨早产儿医院感染的发病情况及危险因素,为医院感染的监控和干预提供理论依据。方法回顾性调查本院2008年1月-2010年1月本院NICU 516例早产儿的临床资料,分析医院感染的危险因素。结果 1.早产儿516例中,74例发生医院感染,发生率为14.3%,共发生医院感染98例次,平均每例发生1.32次,医院感染的住院日相关发生率为8.9‰;感染部位以呼吸道为主(51.0%),其中呼吸机相关性肺炎最为多见(占36.0%),其次为皮肤软组织(26.5%)和消化道(14.3%)。2.共培养出病原菌69株,革兰阴性杆菌占71.0%,以肺炎克雷伯菌最为多见(17.4%);革兰阳性球菌占18.8%,以草绿色链球菌最为多见;真菌占10.1%,主要为白色念珠菌。3.胎龄≤32周、出生体质量≤1.5 kg、羊水胎粪污染、胎膜早破≥48 h、糖尿病母亲儿、吸痰次数≥10次、气管插管次数≥3次、机械通气时间≥3 d、置胃管、静脉营养、应用抗生素时间≥2周及住院时间≥2周与医院感染率显著相关,多元Logistic回归方程显示胎龄≤32周、静脉营养、机械通气时间≥3 d及住院时间≥2周是医院感染发生的独立危险因素。结论 NICU早产儿医院感染的危险因素众多,尽量减少侵入性操作次数、缩短静脉营养及住院的时间、合理应用抗生素可有效降低医院感染发生率。
Objective To investigate the incidence and risk factors of nosocomial infection in premature infants and provide a theoretical basis for the surveillance and intervention of nosocomial infections. Methods The clinical data of 516 NICU preterm infants in our hospital from January 2008 to January 2010 were retrospectively analyzed to analyze the risk factors of nosocomial infection. Among 516 cases of premature infants, 74 cases had nosocomial infection with a rate of 14.3%. There were 98 nosocomial infections in 98 cases, with an average of 1.32 cases in each case. The hospitalization-related incidence of nosocomial infections was 8.9% Respiratory-based (51.0%) was the most common, with ventilator-associated pneumonia the most common (36.0%), followed by skin and soft tissue (26.5%) and digestive tract (14.3%). There were 69 pathogens co-cultivated, Gram-negative bacilli accounted for 71.0%, Klebsiella pneumoniae most common (17.4%); Gram-positive cocci accounted for 18.8%, the most common Streptococcus sobrinus; fungi 10.1%, mainly Candida albicans. 3. gestational age ≤ 32 weeks, birth weight ≤ 1.5 kg, amniotic fluid meconium contamination, premature rupture of membranes ≥ 48 h, children with diabetes, sputum suction ≥ 10 times, tracheal intubation times ≥ 3 times, mechanical ventilation time ≥3 d, gastric tube and vein nutrition, antibiotic time ≥2 weeks and hospitalization ≥2 weeks were significantly correlated with hospital infection rate. Multivariate Logistic regression equation showed gestational age ≤32 weeks, parenteral nutrition, mechanical ventilation ≥3 d And hospitalization ≥ 2 weeks is an independent risk factor for nosocomial infection. Conclusion There are many risk factors for nosocomial infection in preterm infants with NICU. The number of invasive operations and the time of hospitalization are shortened as far as possible. Rational use of antibiotics can effectively reduce the incidence of nosocomial infections.