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目的探讨新生儿重症监护病房(NICU)早产儿医院感染的危险因素和抗生素使用状况,以对早产儿医院感染防控提供依据。方法回顾性分析2009-2011年我院NICU收治的早产儿临床资料,对医院感染发生率、感染的临床特点、危险因素等进行分析。结果 699例早产儿中,144例发生198次医院感染,医院感染发生率20.6%,住院日相关的医院感染发生率为17.5例次/1000住院日;呼吸机相关性肺炎(VAP)发生率74.3例次/1000机械通气日,中心静脉置管相关败血症(CRBSI)发生率2.2例次/1000导管日。发生感染日龄(16.5±12.8)天,发生医院感染的早产儿比未感染者使用抗生素级别更高,住院时间更长,肺部感染占首位,共91例。单因素分析显示,早产儿医院感染的危险因素为男婴、胎龄<32周、体重<1500g、胃肠外营养、机械通气及中心静脉置管时间长(P<0.05),进一步logistic回归分析提示,胎龄<32周(OR=4.21,95%CI1.924～10.915)、胃肠外营养(OR=6.18,95%CI3.187～13.734)、机械通气时间长(OR=6.72,95%CI4.057～11.134)是NICU早产儿医院感染的独立危险因素。结论早产儿是医院感染的高发群体,胎龄<32周、胃肠外营养及机械通气是早产儿医院感染的危险因素。
Objective To investigate the risk factors of nosocomial infection and antibiotic use in neonatal intensive care unit (NICU) premature infants to provide basis for prevention and control of nosocomial infection in premature infants. Methods The clinical data of NICU admitted to our hospital from 2009 to 2011 were retrospectively analyzed. The incidence of nosocomial infection, clinical features and risk factors of infection were analyzed. Results Among 699 premature infants, 144 cases of nosocomial infection occurred in 198 cases, the incidence of nosocomial infection was 20.6%, and the incidence of hospital-related nosocomial infections was 17.5 cases / 1000 hospital days; the incidence of ventilator-associated pneumonia (VAP) was 74.3 Cases / 1000 mechanical ventilation days, central venous catheter-related sepsis (CRBSI) incidence of 2.2 cases / 1000 catheter days. The age of infection (16.5 ± 12.8 days), nosocomial infection occurred in preterm infants with antibiotics than the non-infected patients with higher grade, longer hospital stay, lung infection in the first place, a total of 91 cases. Univariate analysis showed that the risk factors for nosocomial infection in preterm infants were male infants, gestational age <32 weeks, weight <1500g, parenteral nutrition, mechanical ventilation and central venous catheterization for a long time (P <0.05). Further logistic regression analysis (OR = 4.21, 95% CI 1.924-10.915), parenteral nutrition (OR 6.18, 95% CI 3.187-13.734), longer duration of mechanical ventilation (OR = 6.72, 95% CI4.057 ~ 11.134) is an independent risk factor for nosocomial infection in preterm infants with NICU. Conclusions Premature infants are the most frequent hospital infection, gestational age <32 weeks, parenteral nutrition and mechanical ventilation are the risk factors of nosocomial infection in preterm infants.