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目的了解新生儿医院感染现状、特征及相关危险因素,探讨有效的预防控制措施。方法采用主动监测的方法,对本院2010年1月至2012年8月所有住院新生儿进行目标性监测,包括住院患儿数、住院日数、医院感染例数及病原菌分布等,并对结果进行统计分析。结果研究期间共收治新生儿8067例,总住院日83110天,发生医院感染598例、640例次,新生儿医院感染率7.41%,7.20例次/1000住院日,3年间医院感染率差异无统计学意义。医院感染率随着出生体重的升高而降低,以新生儿感染为主(44.1%),其次为胃肠道感染(19.7%)、下呼吸道感染(16.7%),呼吸机相关性肺炎及导管相关性败血症感染率分别为13.09/1000呼吸机使用日和32.26/1000导管日,随着出生体重的升高,呼吸机相关性肺炎的感染率降低。医院感染病原菌主要为革兰阴性杆菌,占45.0%,尤以肺炎克雷伯菌为主,革兰阳性菌占38.8%,主要为葡萄球菌,真菌占16.3%。住院天数(OR=1.061,95%CI1.053～1.069)和侵入性操作(OR=1.858,95%CI1.408～2.449)为医院感染的独立危险因素,出生体重(OR=0.342,95%CI0.307～0.381)为保护因素(P均<0.001)。结论新生儿医院感染与多个因素有关,目标性监测应长期坚持进行,针对危险因素制定一系列的防控措施对预防医院感染的发生尤为重要。
Objective To understand the status, characteristics and related risk factors of neonatal nosocomial infection and to explore effective preventive and control measures. Methods The method of active surveillance was used to monitor the target of all hospitalized newborns in our hospital from January 2010 to August 2012, including the number of hospitalized children, the number of hospitalization days, the number of nosocomial infections and the distribution of pathogens, and the results were carried out Statistical Analysis. Results During the study period, 8067 newborns were enrolled and the total hospitalization days were 81,110 days. There were 598 cases of hospital infection, 640 cases of neonatal hospital infection, 7.41% of hospital infection rate of neonates, 7.20 cases / 1000 hospitalization days. There was no statistical difference in hospital infection rates Significance of learning. The prevalence of nosocomial infection decreased with the increase of birth weight, mainly in neonates (44.1%), followed by gastrointestinal infections (19.7%), lower respiratory tract infections (16.7%), ventilator-associated pneumonia and catheter The related sepsis rates were 13.09 / 1000 days of ventilator use and 32.26 / 1000 catheter days, respectively. As the birth weight increased, the infection rate of ventilator-associated pneumonia decreased. The main pathogens of nosocomial infection were Gram-negative bacilli, accounting for 45.0%, especially Klebsiella pneumoniae, Gram-positive bacteria accounted for 38.8%, mainly Staphylococcus aureus, fungi accounted for 16.3%. The hospitalization days (OR = 1.061, 95% CI 1.053-1.069) and invasive procedures (OR = 1.858,95% CI 1.408-2.449) were independent risk factors for nosocomial infection. The birth weight (OR = 0.342, 95% CI0 .307 ~ 0.381) as protective factors (all P <0.001). Conclusion Neonatal nosocomial infection is related to many factors. Target monitoring should be carried out for a long time. To develop a series of prevention and control measures for risk factors is particularly important to prevent nosocomial infection.