极低出生体质量儿医院感染现状及危险因素分析
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摘要
目的:调查上海市某妇婴保健医院新生儿重症监护室极低出生体质量儿(VLBWI)医院感染现状,分析VLBWI医院感染现状及危险因素。方法:采用回顾性队列研究方法,收集2011-2015年该院新生儿重症监护病房住院时间>48 h VLBWI的病历,基于医院病案管理系统,对所有病历逐一审查,并与医院感染报表结合找出所有医院感染病例。采用Excel录入数据,SPSS24.0进行数据分析。结果:VLBWI医院感染率44.3%,感染部位主要为下呼吸道(14.2%)及血液(11.6%),各年度感染部位构成比差异有统计学意义(P<0.01),感染病例病原菌检出以革兰阴性菌为主(72.4%);多因素logistic回归分析显示,患儿为多胞胎、机械通气及静脉营养时间久、住院时间长及母亲有胎膜早破史是VLBWI医院感染的发生的独立危险因素(P<0.01)。结论:加强围生期保健,对存在高危因素的早产儿,给予高度关注,及时干预。
Objective:To investigate the nosocomial infection status of very-low-birth-weight infants(VLBWI) in the neonatal intensive care unit in a maternal and child health care hospital in Shanghai,and analyze the nosocomial infection status of VLBWI and its risk factors.Methods:According to the retrospective cohort study,the medical histories of all VLBWI with hospitalization time more than 48 hours from 2011 to 2015 were collected.Based on the medical record management system,all data of patients with nosocomial infection were identified according to the nosocomial infection report,and were analyzed using SPSS24.0 software.Results:The infection rate in VLBWI was 44.3%.The main infection sites were lower respiratory tract(14.2%) and blood(11.6%),the difference of the composition ratio of nosocomial infection site was statistically significant in each year(P<0.01),and the gram-negative bacterium was the mainly pathogenic bacterium(72.4%).Multivariate logistic regression analysis showed that the multiple births,long duration of mechanical ventilation,intravenous nutrition and hospitalization,and mother with premature rupture of membrane history were the independent risk factors of nosocomial infection in VLBWI(P<0.01).Conclusions:Strengthening perinatal health care and timely intervening the premature infants with high risk factors should be implemented.
Objective:To investigate the nosocomial infection status of very-low-birth-weight infants(VLBWI) in the neonatal intensive care unit in a maternal and child health care hospital in Shanghai,and analyze the nosocomial infection status of VLBWI and its risk factors.Methods:According to the retrospective cohort study,the medical histories of all VLBWI with hospitalization time more than 48 hours from 2011 to 2015 were collected.Based on the medical record management system,all data of patients with nosocomial infection were identified according to the nosocomial infection report,and were analyzed using SPSS24.0 software.Results:The infection rate in VLBWI was 44.3%.The main infection sites were lower respiratory tract(14.2%) and blood(11.6%),the difference of the composition ratio of nosocomial infection site was statistically significant in each year(P<0.01),and the gram-negative bacterium was the mainly pathogenic bacterium(72.4%).Multivariate logistic regression analysis showed that the multiple births,long duration of mechanical ventilation,intravenous nutrition and hospitalization,and mother with premature rupture of membrane history were the independent risk factors of nosocomial infection in VLBWI(P<0.01).Conclusions:Strengthening perinatal health care and timely intervening the premature infants with high risk factors should be implemented.
引文
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[16] NORWITZ ER,CAUGHEY AB.Progesterone supplementation and the prevention of preterm birth[J].Rev Obstet Gynecol,2011,4(2):60.
[17] XIA H,LI X,LI X,et al.The clinical management and outcome of term premature rupture of membrane in East China:results from a retrospective multicenter study[J].Int J Clin Exp Med,2015,8(4):6212.
[18] VERANI JR,MCGEE L,SCHRAG SJ.Prevention of perinatal group B streptococcal disease--revised guidelines from CDC,2010[J].MMWR Recomm Rep,2010,59(RR-10):1.
[2] PAYNE NR,CARPENTER JH,BADGER GJ,et al.Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants[J].Pediatrics,2004,114(2):348.
[3] ELWARD AM,HOLLENBEAK CS,WARREN DK,et al.Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients[J].Pediatrics,2005,115(4):868.
[4] 邢燕,崔蕴璞,彤妍,等.11年间极低出生体质量儿医院感染的临床分析[J].中华围产医学杂志,2011(1):39.
[5] 徐焱,李文华,王丹华.新生儿重症监护病房早产儿医院感染分析[J].中国学术期刊文摘,2008(3):245.
[6] NEWBY J.Nosocomial infection in neonates:inevitable or preventable?[J].J Perinat Neonatal Nurs,2008,22(3):221.
[7] PAYNE NR,BARRY J,BERG W,et al.Sustained reduction in neonatal nosocomial infections through quality improvement efforts[J].Pediatrics,2012,129(1):e165.
[8] EFIRD MM,ROJAS MA,LOZANO JM,et al.Epidemiology of nosocomial infections in selected neonatal intensive care units in Colombia,South America[J].J Perinatol,2005,25(8):531.
[9] 何少茹,钟敏泉,农绍汉,等.NICU院内感染病原菌流行分布情况及其耐药性变迁[J].临床儿科杂志,2009(3):226.
[10] MAI JY,DONG L,LIN ZL,et al.Investigation and analysis of nosocomial infection in neonates[J].Zhonghua Er Ke Za Zhi,2011,49(12):915.
[11] POLIN RA,DENSON S,BRADY MT.Epidemiology and diagnosis of health care-associated infections in the NICU[J].Pediatrics,2012,129(4):e1104.
[12] 任军红,林金兰,贾会学,等.新生儿重症监护病房医院感染危险因素的调查[J].中华医院感染学杂志,2011(12):2435.
[13] YOUNG BC,WYLIE BJ.Effects of twin gestation on maternal morbidity[J].Semin Perinatol,2012,36(3):162.
[14] 夏敏,杨平,崔伟,等,双胎妊娠早产的临床特点及早产儿结局分析[J/CD].中华妇幼临床医学杂志(电子版),2016(5):590.
[15] 庄艳艳,崔红,刘思诗,等.20年间双胎妊娠并发症变化及妊娠结局的比较分析[J].现代妇产科进展,2014(1):37.
[16] NORWITZ ER,CAUGHEY AB.Progesterone supplementation and the prevention of preterm birth[J].Rev Obstet Gynecol,2011,4(2):60.
[17] XIA H,LI X,LI X,et al.The clinical management and outcome of term premature rupture of membrane in East China:results from a retrospective multicenter study[J].Int J Clin Exp Med,2015,8(4):6212.
[18] VERANI JR,MCGEE L,SCHRAG SJ.Prevention of perinatal group B streptococcal disease--revised guidelines from CDC,2010[J].MMWR Recomm Rep,2010,59(RR-10):1.