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目的探讨新生儿经外周中心静脉置管(PICC)和脐静脉插管(UVC)致血管内导管相关感染(CRBSI)的发生率、危险因素及病原特点。方法 回顾性分析2008年收住我院新生儿重症监护病房(NICU)施行PICC和(或)UVC患儿的临床资料。结果 施行PICC的50例新生儿中有9例发生CRBSI,导管相关血行感染率为6.2/1000血管内导管日(9/1455),施行UVC的111例新生儿中有7例发生CRBSI,导管相关血行感染率为11.6/1000血管内导管日(7/601)。发生CRBSI的危险因素包括出生体重(OR=0.107)、胎龄(OR=0.320)和性别(OR=5.526)(P均<0.05)。多因素Logistic回归分析显示出生体重(OR=0.068,95%CI0.009～0.495)、性别(OR=9.665,95%CI1.976～47.263)是患儿发生CRBSI的独立相关危险因素(P均<0.05)。在检出的病原体中,以凝固酶阴性葡萄球菌为主,占54.5%,主要是多重耐药菌,表现为耐甲氧西林和β内酰胺酶阳性。结论 新生儿发生CRBSI的危险因素为出生体重、胎龄和男婴,致病菌大多为多重耐药菌。
Objective To investigate the incidence, risk factors and pathogens of neonatal intracoronary catheter-associated infection (CRBSI) caused by peripheral central venous catheter (PICC) and umbilical vein catheterization (UVC). Methods We retrospectively analyzed the clinical data of patients with PICC and / or UVC admitted to neonatal intensive care unit (NICU) in our hospital in 2008. Results CRBSI occurred in 9 out of 50 neonates who underwent PICC. The catheter-associated bloodstream infection rate was 6.2 / 1000 intravascular catheter day (9/1455), and CRBSI was associated with ductal involvement in 7 of 111 neonates who underwent UVC Bloodstream infection rate was 11.6 / 1000 intravascular catheter days (7/601). Risk factors for CRBSI included birth weight (OR = 0.107), gestational age (OR = 0.320) and gender (OR = 5.526) (all P <0.05). Multivariate logistic regression analysis showed that birth weight (OR = 0.068,95% CI0.009-0.495) and gender (OR = 9.665,95% CI1.976-47.263) were independent risk factors for CRBSI in children (all P < 0.05). Among the detected pathogens, coagulase-negative staphylococci accounted for 54.5%, mainly multi-resistant bacteria, showing methicillin-resistant and β-lactamase-positive. Conclusion The risk factors of CRBSI in neonates are birth weight, gestational age and male infants. Most of the pathogens are multidrug-resistant bacteria.