新生儿感染性疾病主要致病菌及诱发感染的危险因素分析
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摘要
目的探讨新生儿感染性疾病细菌及其危险因素,为降低新生儿感染率提供参考依据。方法回顾性分析2016年1月至2016年12月濮阳市中医院小儿重症监护病房(NICU)收治的1 080例新生儿病人临床资料,对发生各系统感染的128例患儿,综合分析感染发生部位、疾病种类、细菌特征及危险因素。结果 1 080例病人中各种感染128例,感染发生率11.85%;感染部位:呼吸系统感染60例(46.87%),血流感染38例(29.68%),皮肤、软组织损伤感染17例(13.28%),其它部位感染13例(10.16%);新生儿感染主要致病菌为肺炎克雷伯菌28株(21.88%)、凝固酶阴性葡萄球菌29株(22.66%)、大肠埃希菌22株(17.19%)、B族链球菌(GBS)12株(9.38%);在可能导致感染的因素中,新生儿性别和分娩方式之间差异无统计学意义(P>0.05),胎龄、低体质量、住院时间、机械通气、侵入性操作、入住暖箱、羊水污染、胎膜早破、围产妇B族链球菌(GBS)筛查之间均差异有统计学意义(P<0.05)。结论新生儿感染细菌广、危险因素多,合理选择抗菌药物,及时发现可能诱发感染的危险因素,并制定相应的防御措施,是降低新生儿感染性疾病发生率和多重耐药菌在新生儿病房传播的重要措施。
Objective To investigate the bacteria of neonatal infection disease and its risk factors and to provide reference for clinical neonatal infection.Methods A retrospective study was conducted on the clinical data of 1 080 neonatal patients admitted to our hospital neonatal intensive care unit(NICU) from January 2016 to December 2016.Cases of 128 neonatal patients with systemic infections were analyzed comprehensively in the sites of infection,disease types,bacteria characteristics and risk factors.Results Among all the 1 080 patients,128 patients were infected thus the infectious rate was 11.85 %.Among the infectious cases,there were 60 cases of respiratory infection(46.87%),38 cases of bloodstream infection(29.68 %),17 cases of skin and soft tissue injury and infection(13.28%),and 13 cases of other sites of the infection(10.16%).The main pathogens of neonatal infection included 28 strains of Klebsiella pneumoniae(21.88%),29 strains of coagulase negative staphylococcus(22.66%),22 strains of Escherichia coli(17.19%),and 12 strains of Group B Streptococcus(GBS)(9.38%).Except for the gender and modes of delivery,other factors that might induce infections such as gestational age,low birth weight,hospitalization time,mechanical ventilation,invasive operation,incubator occupancy,amniotic fluid contamination,premature rupture of membranes and GBS screening for women in the period of late pregnancy were all statistically significant(P<0.05).Conclusions There are a wide range of neonatal infection pathogens and various risk factors.Rational selection of antibiotics,timely investigating of possible risk factors for infection,and developing corresponding preventive measures are important measures to reduce the number of neonates with infectious disease and to lower the risk of spreading multidrug-resistant bacteria in neonatal wards.
Objective To investigate the bacteria of neonatal infection disease and its risk factors and to provide reference for clinical neonatal infection.Methods A retrospective study was conducted on the clinical data of 1 080 neonatal patients admitted to our hospital neonatal intensive care unit(NICU) from January 2016 to December 2016.Cases of 128 neonatal patients with systemic infections were analyzed comprehensively in the sites of infection,disease types,bacteria characteristics and risk factors.Results Among all the 1 080 patients,128 patients were infected thus the infectious rate was 11.85 %.Among the infectious cases,there were 60 cases of respiratory infection(46.87%),38 cases of bloodstream infection(29.68 %),17 cases of skin and soft tissue injury and infection(13.28%),and 13 cases of other sites of the infection(10.16%).The main pathogens of neonatal infection included 28 strains of Klebsiella pneumoniae(21.88%),29 strains of coagulase negative staphylococcus(22.66%),22 strains of Escherichia coli(17.19%),and 12 strains of Group B Streptococcus(GBS)(9.38%).Except for the gender and modes of delivery,other factors that might induce infections such as gestational age,low birth weight,hospitalization time,mechanical ventilation,invasive operation,incubator occupancy,amniotic fluid contamination,premature rupture of membranes and GBS screening for women in the period of late pregnancy were all statistically significant(P<0.05).Conclusions There are a wide range of neonatal infection pathogens and various risk factors.Rational selection of antibiotics,timely investigating of possible risk factors for infection,and developing corresponding preventive measures are important measures to reduce the number of neonates with infectious disease and to lower the risk of spreading multidrug-resistant bacteria in neonatal wards.
引文
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[2] 王卫平.儿科学[M].8版,北京:人民卫生出版社,2013:128.
[3] 李小盼,李世清,胡瑜.护理干预联合氧驱动雾化对小儿重症肺炎咳嗽的临床观察研究[J].安徽医药,2014,18(6):1179-1181.
[4] 江玉凤,陈敏利,符慧玉,等.新生儿感染性肺炎危险因素分析与预防措施[J].中华医院感染学杂志,2016,26(6):1387-1389.
[5] 顾雯雯.新生儿感染性疾病危险因素分析与对策[J].中华实验和临床感染病杂志(电子版),2016,10(1):93-95.
[6] 操晓莉,陈梅俐.新生儿败血症的病原菌及耐药分析[J].安徽医药,2013,17(6):1015-1016.
[7] 毛立英.新生儿感染的病原菌分布特点与耐药性及危险因素分析[J].中华医院感染学杂志,2013,23(2):382-384.
[8] SAVARD N,LEVALLOIS P,RIVEST LP,et al.Impact of individual and ecological characteristics on small for gestational age births:anobservational study in Quebec[J].Chronic Dis Inj Can,2014,34(1):46-45.
[9] 谢朝云,熊芸,孙静,等.新生儿重症监护病房多重耐药菌感染危险因素logistic回归分析[J].临床儿科杂志,2016,34(9):641-644.
[10] 邹晓萍,窦贺荣,史海霞,等.胎膜早破后残余羊水指数与母儿预后的关系探讨[J].安徽医药,2013,17(4):584-585.
[11] 龙彪.早产儿并胎膜早破的新生儿预后临床分析[J].内蒙古中医药,2012,31(13):41.
[12] 宋晓英,赵力力,李永强,等.胎膜早破病例发生的同时与新生儿感染症状合并的风险探讨[J].中国农村卫生,2013(zl):75.
[13] 蔡晓沂,钟镐镐,王秀艳,等.快速、准确的B族链球菌检测-即时荧光探针核酸扩增技术的应用[J].现代预防医学,2013,40(13):2533-2535.