目的：了解近年来新生儿重症监护病房（NICU）医院感染的发生情况,探讨其危险因素,分析病原菌的流行分布情况,为临床合理使用抗生素提供依据。方法：采用回顾性调查方法对1 100例疑合并医院感染患儿进行医院感染监控,观察感染发生率、感染部位。结果：1 100例患儿中106例发生125次医院感染,725份标本共分离出病原菌68株,阳性率为9.3%（68/725）,平均医院感染发生率为9.63%（106/1 100）。医院感染的危险因素包括胎龄≤32周、机械通气、静脉营养及小于胎龄儿（P〈0.05）。医院感染病死率为5.6%（6/106）;前3位病原菌为葡萄球菌、肺炎克雷伯杆菌和大肠杆菌;感染部位中以呼吸道感染占首位（40.0%,50/125）;呼吸道医院感染病原菌前3位：克雷伯杆菌、铜绿假单胞菌和肺炎链球菌。细菌耐药情况：阳性菌对青霉素G、氨苄西林、头孢唑啉的耐药性较高,而对替考拉宁、万古霉素和利奈唑胺保持100%敏感;革兰阴性杆菌对头孢二、三代抗生素耐药性高,但对碳青霉烯类和氨基糖甙类抗生素敏感。结论：1医院感染的主要危险因素是机械通气、胎龄≤32周的早产儿和静脉营养;2考虑病原体培养阳性率较低,在严重感染时,病原体培养结果回报前,给予针对葡萄球菌和肺炎克雷白杆菌的抗生素联合抗感染为佳。
Objective： To understand the prevalence of nosocomial infection in NICU,explore the risk factors,analyze the distribution and prevalence of pathogens,provide a basis for reasonable use of antibiotics in clinic. Methods： A retrospective investigation was performed to survey 1 100 children suspected of nosocomial infection, the incidence rate and site of nosocomial infection were observed. Results： Among 1 100 children,125 times of nosocomial infection occurred in 106 children,sixty- eight pathogenic strains were separated from 725 specimens,the positive rate was 9. 3%（ 68 /725）. The total nosocomial infection rate was 9. 63%（ 106 /1 100）. The risk factors of nosocomial infection included gestational age≤32 weeks,mechanical ventilation,vein nutrition and small for gestational age infant（ P〈0. 05）. The mortality rate of nosocomial infection was 5. 6%（ 6 /106）. The top three pathogens were Staphylococci,Klebsiella pneumonia and Escherichia coli; respiratory tract was the most common site of nosocomial infection（ 40. 0%,50 /125）. Among the children with respiratory tract infection,the top three pathogens were Klebsiella pneumonia,Pseudomonas aeruginosa and Streptococcus pneumoniae. Gram- positive bacteria were highly resistant to penicillin G,ampicillin and cefazolin,but Gram- positive bacteria were sensitive to teicoplanin,vancomycin and linezolid,the sensitivities were 100%; Gram- negative bacteria were highly resistant to the second or the third generation cephalosporin,but Gram- negative bacteria were sensitive to carbapenem. Conclusion： The main risk factors of nosocomial infection are mechanical ventilation,gestational age≤32 weeks and intravenous nutrition; considering the low positive rate of pathogen culture,antibiotics targeting to Staphylococcus aureus and Klebsiella pneumonia should be applied for the children with severe nosocomial infection before obtaining the report of pathogens culture results.
Maternal and Child Health Care of China