新生儿重症监护病房医院感染流行病学研究
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摘要
目的调查新生儿重症监护病房(NICU)医院感染的特点,为预防和控制NICU医院感染提供科学依据。方法监测2013年1月—2017年12月某院NICU入住时间>48 h的住院新生儿的医院感染发生情况,并分析其医院感染发病特征及病原菌种类。结果 2013年1月—2017年12月NICU共监测新生儿10 551例,发生医院感染257例,270例次;医院感染发病率2.44%,例次医院感染发病率为2.56%,例次日感染发病率为2.31‰。不同性别医院感染发病率比较,差异无统计学意义(P>0.05)。不同出生体重、有无气管插管的新生儿医院感染发病率比较,差异均有统计学意义(均P<0.001)。不同年份例次医院感染发病率比较,差异有统计学意义(P<0.05)。医院感染部位以下呼吸道为主,占65.19%(其中VAP占36.30%);其次是血液(22.22%)。共检出病原菌169株,以革兰阴性菌为主,其中居前3位分别为鲍曼不动杆菌(26.03%)、肺炎克雷伯菌(22.49%)、大肠埃希菌(19.53%)。结论低出生体重及侵入性操作是NICU住院新生儿发生医院感染的危险因素。减少各种侵入性操作,严格掌握各种置管指征,加强产前孕母的宣教与营养指导,将胎儿的出生体重维持在合理范围均是预防NICU住院新生儿医院感染的关键。
Objective To investigate the characteristics of healthcare-associated infection(HAI)in neonatal intensive care unit(NICU),and provide scientific basis for the prevention and control of HAI in NICU.Methods The occurrence of HAI in newborns who were hospitalized in NICU for>48 hours from January 2013 to December 2017 was monitored,and characteristics of HAI and types of pathogens were analyzed.Results From January 2013 to December 2017,a total of 10 551 newborns in NICU were monitored,257 newborns had 270 cases of HAI;incidence and case incidence of HAI were 2.44% and 2.56% respectively,incidence of HAI per 1 000 day was 2.31,There was no significant difference in the incidence of HAI between different genders(P>0.05).Incidence of HAI in newborns with different birth weight as well as with or without tracheal intubation was significantly different(all P<0.001).Case incidences of HAI among different years were significantly different(P<0.05).The main HAI site was lower respiratory tract,accounting for 65.19%(ventilalor-associated pneumonia accounted for 36.30%),followed by blood stream(22.22%).A total of 169 strains of pathogens were isolated,mainly gram-negative bacteria,the top three were Acinetobacter baumannii(26.03%),Klebsiella pneumoniae(22.49%)and Escherichia coli(19.53%).Conclusion Low birth weight and invasive operation are risk factors for HAI in newborns in NICU.Reducing invasive operation,strictly mastering various indications of catheterization,strengthening prenatal education and nutritional guidance,and maintaining fetal birth weight in a reasonable range are the key to prevent HAI in NICU patients.
Objective To investigate the characteristics of healthcare-associated infection(HAI)in neonatal intensive care unit(NICU),and provide scientific basis for the prevention and control of HAI in NICU.Methods The occurrence of HAI in newborns who were hospitalized in NICU for>48 hours from January 2013 to December 2017 was monitored,and characteristics of HAI and types of pathogens were analyzed.Results From January 2013 to December 2017,a total of 10 551 newborns in NICU were monitored,257 newborns had 270 cases of HAI;incidence and case incidence of HAI were 2.44% and 2.56% respectively,incidence of HAI per 1 000 day was 2.31,There was no significant difference in the incidence of HAI between different genders(P>0.05).Incidence of HAI in newborns with different birth weight as well as with or without tracheal intubation was significantly different(all P<0.001).Case incidences of HAI among different years were significantly different(P<0.05).The main HAI site was lower respiratory tract,accounting for 65.19%(ventilalor-associated pneumonia accounted for 36.30%),followed by blood stream(22.22%).A total of 169 strains of pathogens were isolated,mainly gram-negative bacteria,the top three were Acinetobacter baumannii(26.03%),Klebsiella pneumoniae(22.49%)and Escherichia coli(19.53%).Conclusion Low birth weight and invasive operation are risk factors for HAI in newborns in NICU.Reducing invasive operation,strictly mastering various indications of catheterization,strengthening prenatal education and nutritional guidance,and maintaining fetal birth weight in a reasonable range are the key to prevent HAI in NICU patients.
引文
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[3]Sharma D,Shastri S.Lactoferrin and neonatology-role in neonatal sepsis and necrotizing enterocolitis:present,past and future[J].J Matern Fetal Neonatal Med,2016,29(5):763-770.
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[13]Klevens RM,Edwards JR,Richards CL Jr,et al.Estimating healthcare-associated infections and deaths in U.S.hospitals,2002[J].Public Health Rep,2007,122(2):160-166.
[14]Couto RC,Carvalho EA,Pedrosa TM,et al.A10-year prospective surveillance of nosocomial infections in neonatal intensive care units[J].Am J Infect Control,2007,35(3):183-189.
[15]Sarvikivi E,Karki T,Lyytikainen O,et al.Repeated prevalence surveys of healthcare-associated infections in Finnish neonatal intensive care units[J].J Hosp Infect,2010,76(2):156-160.
[16]徐华,李卫光,顾安曼,等.NICU医院感染目标性监测与干预研究[J].中华医院感染学杂志,2015,25(21):4982-4984.
[17]张慧,尹维佳,郑勇,等.NICU医院感染目标性监测及危险因素分析[J].中华医院感染学杂志,2014,24(14):3544-3546.
[18]郭瑞霞,文海燕,耿庆红.NICU患儿病原菌感染与定植调查分析[J].中华医院感染学杂志,2015,25(9):2120-2122.
[19]付瑞红,温静静,李琳,等.NICU医院感染相关因素分析[J].中华医院感染学杂志,2014,24(1):105-106,109.
[20]高杰,李英,谌丽娟,等.NICU新生儿医院感染特点与病原菌分析[J].中华医院感染学杂志,2016,26(2):427-428,437.
[21]贾会学,殷环,吴安华,等.新生儿重症监护病房医院感染流行病学多中心研究[J].中国感染控制杂志,2015,14(10):649-653.
[22]Thakuria B,Singh P,Agrawal S,et al.Profile of infective microorganisms causing ventilator-associated pneumonia:A clinical study from resource limited intensive care unit[J].Anaesthesiol Clin Pharmacol,2013,29(3):361-366.
[2]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,2011,21(12):2435-2437.
[3]Sharma D,Shastri S.Lactoferrin and neonatology-role in neonatal sepsis and necrotizing enterocolitis:present,past and future[J].J Matern Fetal Neonatal Med,2016,29(5):763-770.
[4]Cakir Edis E,Hatipoglu ON,Y1lmam ·I,et al.Economic burden of nosocomial pneumonia in non-intensive care clinics[J].Tuberk Toraks,2015,63(1):8-12.
[5]党晓燕,孙吉花,陈晓.不同体质量对新生儿医院感染住院费用的影响分析[J].中华医院感染学杂志,2017,27(18):4232-4234,4316.
[6]吴松杰,金学兰,李源,等.新生儿重症监护病房医院感染的直接经济损失研究[J].中华医院感染学杂志,2018,28(7):1110-1113.
[7]中华人民共和国卫生部.医院感染监测规范[S].北京,2009.
[8]中华人民共和国卫生部.医院感染诊断标准(试行)[S].北京,2001.
[9]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[10]中华医学会重症医学分会.血管内导管相关感染的预防与治疗指南(2007)[J].中国实用外科杂志,2008,28(6):413-421.
[11]任军红,吴安华,胡必杰,等.新生儿重症监护病房医务人员手卫生依从性多中心研究[J].中国新生儿科杂志,2015,30(6):438-441.
[12]任军红,殷环,吴安华,等.新生儿重症监护病房器械相关感染流行病学多中心研究[J].中国感染控制杂志,2015,14(8):530-534.
[13]Klevens RM,Edwards JR,Richards CL Jr,et al.Estimating healthcare-associated infections and deaths in U.S.hospitals,2002[J].Public Health Rep,2007,122(2):160-166.
[14]Couto RC,Carvalho EA,Pedrosa TM,et al.A10-year prospective surveillance of nosocomial infections in neonatal intensive care units[J].Am J Infect Control,2007,35(3):183-189.
[15]Sarvikivi E,Karki T,Lyytikainen O,et al.Repeated prevalence surveys of healthcare-associated infections in Finnish neonatal intensive care units[J].J Hosp Infect,2010,76(2):156-160.
[16]徐华,李卫光,顾安曼,等.NICU医院感染目标性监测与干预研究[J].中华医院感染学杂志,2015,25(21):4982-4984.
[17]张慧,尹维佳,郑勇,等.NICU医院感染目标性监测及危险因素分析[J].中华医院感染学杂志,2014,24(14):3544-3546.
[18]郭瑞霞,文海燕,耿庆红.NICU患儿病原菌感染与定植调查分析[J].中华医院感染学杂志,2015,25(9):2120-2122.
[19]付瑞红,温静静,李琳,等.NICU医院感染相关因素分析[J].中华医院感染学杂志,2014,24(1):105-106,109.
[20]高杰,李英,谌丽娟,等.NICU新生儿医院感染特点与病原菌分析[J].中华医院感染学杂志,2016,26(2):427-428,437.
[21]贾会学,殷环,吴安华,等.新生儿重症监护病房医院感染流行病学多中心研究[J].中国感染控制杂志,2015,14(10):649-653.
[22]Thakuria B,Singh P,Agrawal S,et al.Profile of infective microorganisms causing ventilator-associated pneumonia:A clinical study from resource limited intensive care unit[J].Anaesthesiol Clin Pharmacol,2013,29(3):361-366.