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目的调查 NICU 院内感染的发生情况,探讨其危险因素,为院内感染的防控提供依据。方法对我科2003年5月至2004年12月,住院的638例新生儿进行院内感染的监控,并进行分析和总结。结果 638例新生儿中74例发生88次院内感染,发生率为11.6%;住院日相关的院内感染率为14.9/1000NICU 病例-天;导管相关血行感染率为18/1000血管内导管-天(2/111);呼吸机相关肺炎发生率为63.3/1000机械通气-天(15/237);平均开始出现感染时间(7.98±4.58)d。发生院内感染者比未感染者的胎龄及出生体重低、住院时间延长。新生儿发生院内感染的危险因素包括胃肠外营养、出生体重≤1500 g 及呼吸机治疗等(P<0.05)。感染部位中,以肺炎占首位(45.4%)。院内感染病死率为4.1%。入院后有细菌定植者较无定植者院内感染率高(χ~2=79.7,P<0.001)。结论充分了解 NICU 中新生儿发生院内感染的高危因素、尽量减少肠外营养及侵袭性操作的次数和时间、明确 NICU 中患儿个体细菌的定植情况将有助于控制院内感染并对临床合理用药提供参考。
Objective To investigate the incidence of nosocomial infections in NICU and to explore the risk factors for the prevention and control of nosocomial infections. Methods From May 2003 to December 2004, 638 newborns in our hospital were monitored for nosocomial infection and analyzed and summarized. RESULTS: Of the 638 newborns, 74 were found to have nosocomial infections in 88 (11.6%); hospital-associated nosocomial infections were 14.9 / 1000 NICU-days; catheter-associated bloodstream infections were 18/1000 intravascular catheter-days 2/111). The incidence of ventilator-associated pneumonia was 63.3 / 1000 mechanical ventilation-days (15/237). On average, the onset of infection was (7.98 ± 4.58) days. The incidence of nosocomial infections than those without gestational age and birth weight is low, prolonged hospitalization. Risk factors for neonatal nosocomial infections include parenteral nutrition, birth weight ≤ 1500 g, and ventilator therapy (P <0.05). Of the infected sites, pneumonia accounted for the highest (45.4%). Hospital infection mortality was 4.1%. After hospital admission, there was a higher rate of nosocomial infection among patients with bacterial colonization (χ ~ 2 = 79.7, P <0.001). CONCLUSIONS To fully understand the high risk factors of neonatal nosocomial infection in the NICU, minimize the number and time of parenteral nutrition and invasive procedures, and clarify the colonization of individual bacteria in the NICU will help control nosocomial infections and rational clinical use for reference.