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目的了解我国三级甲等综合医院新生儿监护病房(NICU)器械相关感染的流行特点,为预防和控制新生儿器械相关感染提供科学依据。方法以多中心研究的方式,选取全国9个省及直辖市17所医院2013年10月—2014年9月NICU住院新生儿,按照统一的诊断标准和方法,对器械相关感染进行前瞻性监测。结果共监测12 998例NICU住院新生儿,住院总日数为126 125 d,发生13例中央导管相关血流感染(CLABSI)、70例呼吸机相关肺炎(VAP),中央静脉导管使用率为15.56%,CLABSI发病率为0.66‰;呼吸机使用率为7.67%,VAP发病率为7.23‰。≤1 000 g体重组中央静脉导管和呼吸机使用率最高,分别为61.06%和29.91%;床位数20~30张的NICU中央静脉导管使用率(16.67%)最高,呼吸机使用率(4.11%)最低;中央静脉导管和呼吸机使用率均以西南地区最高。不同规模NICU新生儿VAP发病率以床位数20~30张的NICU最低(2.36‰)。不同地区NICU新生儿CLABSI、VAP发病率比较,差异均有统计学意义;CLABSI和VAP发病率均以华南地区最高(分别为2.68‰、31.06‰)、西南地区次之。不同季度NICU新生儿CLABSI、VAP发病率比较,差异均无统计学意义(均P>0.05)。结论我国NICU器械使用率及其相关感染率较高,不同出生体重组、不同规模NICU、不同地区存在差异,应继续加强监测,根据感染特点落实防控措施。
Objective To understand the epidemiological characteristics of NICU-related infections in Class III A general hospitals in China and provide a scientific basis for the prevention and control of neonatal device-related infections. METHODS: A multicenter study was conducted to select 17 hospitals in 9 provinces and municipalities in China for NICU inpatients from October 2013 to September 2014. Prospective monitoring of device-related infections was performed according to uniform diagnostic criteria and methods. Results A total of 12,998 NICU inpatients were monitored for a total hospital stay of 126 125 days. Thirteen cases of central catheter-associated bloodstream infection (CLABSI) and 70 cases of ventilator-associated pneumonia (VAP) were observed. The rate of central venous catheterization was 15.56% , The incidence of CLABSI was 0.66 ‰; the rate of ventilator utilization was 7.67% and the incidence of VAP was 7.23 ‰. The central venous catheter and ventilator utilization rates were the highest in the group of ≤1 000 g body weight (61.06% and 29.91% respectively); the central venous catheter utilization rate (16.67%) was the highest in NICU with 20-30 beds, the ventilator utilization rate was 4.11% ) Lowest; central venous catheter and ventilator utilization rates are the highest in the southwestern region. The incidence of neonatal VAP in NICU of different sizes is the lowest (2.36 ‰) with 20-30 beds. The prevalence rates of CLABSI and VAP in neonates with NICU in different areas were statistically different. The incidence rates of CLABSI and VAP were the highest in South China (2.68 ‰ and 31.06 ‰, respectively), followed by the southwestern areas. There was no significant difference in the incidence of neonatal CLABSI and VAP between NICU in different quarters (all P> 0.05). Conclusion The prevalence of NICU and related infections in NICU in China is high. Different birth weight groups, NICU of different scales and different regions have differences. Monitoring and surveillance should be continued to be implemented, and prevention and control measures should be implemented according to the characteristics of infection.