摘要
目的分析新生儿重症监护室发生院内感染的危险因素,并为此类患儿的临床诊疗提供循证支持。方法以2014年1月至2017年12月扬州大学附属医院儿科新生儿重症监护室收诊的82例新生儿患儿为研究对象。对患儿的出生体重、胎龄、Apgar评分等进行记录;对患儿病原菌感染情况进行检测。结果新生儿发生上呼吸道感染所占百分比最高,占25.61%,其次为下呼吸道感染,所占比例为21.95%,再者为血行感染,所占比例为15.85%。42例细菌培养阳性感染组患儿中共分离出53株病原菌菌株,其中革兰阴性32株(60.38%),革兰阳性21株(39.62%)。革兰阴性菌主要包含肺炎克雷伯杆菌和大肠埃希菌,其中前者对头孢曲松的耐药率最高,达87.50%,后者对头孢曲松的耐药率最高,达92.31%。革兰阳性菌主要包含凝固酶阴性葡萄球菌和金黄色葡萄球菌,其中前者对青霉素的耐药率最高,达83.33%,后者对青霉素耐药率最高,达100%。通过Logistic单因素回归分析,发现重症监护室新生儿的出生体重、联合使用抗菌药物、抗菌药物使用时间均是发生多重耐药菌感染的独立危险因素。结论重症监护室新生儿的病情较为凶险,若发生院内感染,则将明显增加治疗难度。应保证医护人员手部清洁,尽可能减少各项有创性操作,定期开展消毒及感染监测,以减少院内感染事件的发生。
Objective To analyze the risk factors of nosocomial infection in neonatal intensive care unit,and to provide evidence for clinical diagnosis and treatment.Methods A total of 82 neonates who were admitted in the neonatal intensive care unit from January 2014 to December 2017 were enrolled.Their birth weight,gestational age,and Apgar score were recorded.The pathogen infection was detected.Results The incidence of upper respiratory tract infection was the highest in newborns,accounting for 25.61%,followed by 21.95%of lower respiratory tract infections,and 15.85%of hematogenous infections.A total of 53 pathogenic strains were isolated from 42 children with positive bacterial cultures,of which 32 strains(60.38%)were gram-negative bacteria and 21 ones(39.62%)were gram-positive bacteria.Gram-negative bacteria mainly include Klebsiella pneumoniae and Escherichia coli,in which the former has the highest resistance rate to ceftriaxone,reaching 87.50%,and the latter has the highest resistance rate to ceftriaxone,reaching 92.31%.Gram-positive bacteria mainly contain coagulase-negative staphylococci and Staphylococcus aureus.The former has the highest resistance rate to penicillin,reaching 83.33%.The latter has the highest resistance rate to penicillin,reaching 100%.Through logistic regression analysis,the birth weight of neonates in the intensive care unit,the combined use of antibiotics and the duration of antibiotic use were independent risk factors for multidrug-resistant infection in these children.Conclusions Neonatal conditions in intensive care units are dangerous.If a hospital infection occurs,it will significantly increase the difficulty of treatment.Hand hygiene should be ensured,all invasive procedures should be minimized,and disinfection and infection monitoring should be performed regularly to reduce the incidence of nosocomial infections.
作者
刘凤
施益农
LIU Feng;SHI Yinong(Department of Pediatrics,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225000,China;Department of Pediatrics,Jiangsu Second Hospital of Traditional Chinese Medicine,Nanjing,Jiangsu 210017)
出处
《徐州医科大学学报》
CAS
2021年第2期146-149,共4页
Journal of Xuzhou Medical University
基金
江苏省卫生厅科研课题(LZ13098)。
关键词
新生儿
重症监护室
院内感染
危险因素
neonate
intensive care unit
nosocomial infection
risk factors
