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目的分析早产儿医院感染现状、特征及相关危险因素。方法温州市儿童医院新生儿科2011年1月至2012年12月开展医院感染目标性监测,将入住时间>48 h的早产儿医院感染情况进行分析,并分析其高危因素。结果研究期间共纳入早产儿563例,总住院日6310天,51例发生医院感染,共61例次,感染率9.1%,8.1例次/1000住院日。呼吸机相关性肺炎感染率17.2%,37.3例/1000呼吸机使用日;脐静脉、外周中心静脉置管血管相关性感染率12.5%,8.7例/1000导管日。早产儿医院感染病原菌主要为革兰阴性菌,占68.0%,其中肺炎克雷伯菌占24.0%,革兰阳性菌占20.0%,真菌占12.0%。多因素Logistic回归分析显示,胎龄小(OR=1.079,95%CI 1.025~1.136)、极低出生体重(OR=1.053,95%CI 1.038~1.069)、机械通气治疗(OR=4.850,95%CI 3.035~7.751)、胃肠外营养时间(OR=3.180,95%CI 2.058~4.915)、中心静脉置管(OR=4.509,95%CI 2.275~8.935)是早产儿发生医院感染的高危因素。结论早产儿发生医院感染率较高,存在诸多医院感染易感因素,目标监测对采取防控措施有指导意义。
Objective To analyze the status, characteristics and related risk factors of nosocomial infection in premature infants. Methods Neonatology department of Wenzhou Children’s Hospital from January 2011 to December 2012 carried out targeted surveillance of nosocomial infection and analyzed the prevalence of nosocomial infection in premature infants who were admitted for more than 48 hours and analyzed their risk factors. Results A total of 563 preterm infants were enrolled during the study period, with a total inpatient day of 6310 days and 51 nosocomial infections in 61 cases, with an infection rate of 9.1% and 8.1 cases / 1000 hospital days. Ventilator-associated pneumonia infection rate was 17.2%, 37.3 cases / 1000 ventilator use day; umbilical vein, peripheral venous catheter vascular infection rate was 12.5%, 8.7 cases / 1000 catheter day. The main pathogen of nosocomial infection in preterm infants was Gram-negative bacteria, accounting for 68.0%, of which Klebsiella pneumoniae accounted for 24.0%, Gram-positive bacteria accounted for 20.0% and fungi accounted for 12.0%. Multivariate logistic regression analysis showed that gestational age was significantly lower (OR = 1.079, 95% CI 1.025-1.13 6), very low birth weight (OR = 1.053, 95% CI 1.038-1.069) CI 3.035-7.751), parenteral nutrition time (OR = 3.180, 95% CI 2.058-4.915) and central venous catheterization (OR = 4.509,95% CI 2.275- 8.935) were the risk factors for nosocomial infection in preterm infants. Conclusion The prevalence of nosocomial infection in preterm infants is high, and there are many susceptible factors of nosocomial infection. The monitoring of target has guiding significance in taking prevention and control measures.