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目的观察NICU细菌定植及医院感染情况,以降低NICU医院感染发病率。方法 2009年1-12月在本院NICU住院的465例新生儿入院时行痰培养,进行定植菌检测。机械通气患儿更换或拔除气管插管时,常规留气管插管头行细菌培养。所有培养阳性结果行药敏试验。住院时间>48 h的426例新生儿纳入医院感染调查,疑似医院感染时,根据临床表现行相关病原学检查。计算医院感染发病率、日医院感染发病率、呼吸机相关性肺炎(VAP)发病率。结果 465例新生儿行痰培养,72.7%(338/465例)有细菌定植,其中38.8%为正常菌群,61.2%为致病菌。定植的致病菌主要为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌。医院感染发病率为12.4%(53/426例),日医院感染发病率为12.1‰,呼吸机使用率为2.5%,VAP发病率为65.6‰。不同出生体质量组新生儿医院感染发病率差异有统计学意义(2χ=12.35,P<0.05),出生体质量≤1 500 g的新生儿医院感染发病率最高。有致病菌定植的新生儿医院感染发病率高于无致病菌定植的新生儿,差异有统计学意义(2χ=19.88,P<0.05)。结论细菌(尤其是致病菌)定植在NICU很常见,革兰阴性细菌是常见定植致病菌,致病菌定植与医院感染密切相关。对NICU住院患儿进行定植菌检测,有助于减少医院感染的发生。
Objective To observe the NICU bacterial colonization and hospital infection in order to reduce the incidence of NICU hospital infection. Methods 465 newborns hospitalized in our NICU from January to December 2009 were sputum cultured and tested for colonization. Mechanical ventilation in children to replace or remove the tracheal intubation, the conventional tracheal intubation head line bacterial culture. All culture positive results line drug sensitivity test. 426 cases of newborns hospitalized for> 48 h were included in the nosocomial infection survey, suspected nosocomial infection, according to the clinical manifestations of the relevant etiological examination. The incidence of nosocomial infections, the incidence of nosocomial infections, and the incidence of ventilator-associated pneumonia (VAP) were calculated. Results 465 neonates were sputum culture, 72.7% (338/465 cases) of bacterial colonization, of which 38.8% of the normal flora, 61.2% of pathogens. Colonization of the main pathogens are Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus. The incidence of nosocomial infection was 12.4% (53/426 cases). The incidence rate of nosocomial infection was 12.1%. The ventilator utilization rate was 2.5%. The incidence of VAP was 65.6%. The incidence of nosocomial infections in neonates with different birth weight groups was significantly different (2χ = 12.35, P <0.05). The incidence of nosocomial infections was the highest in neonates with birth mass less than 1 500 g. The incidence of nosocomial infection of neonates colonized by pathogenic bacteria was higher than that of neonates colonized by non-pathogenic bacteria, the difference was statistically significant (2χ = 19.88, P <0.05). Conclusion Colonization of bacteria, especially pathogenic bacteria, is common in NICU. Gram-negative bacteria are common colonization pathogens. Pathogenic bacteria colonization is closely related to nosocomial infection. Colonization of NICU inpatients with bacteria detection, will help reduce the incidence of nosocomial infections.