新生儿重症监护室患儿院内感染病原菌分布及院内感染的危险因素分析

doi:10.7499/j.issn.1008-8830.2013.02.010

摘要
图/表
参考文献(14)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (932 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的：了解新生儿重症监护室(NICU)患儿院内感染病原菌分布及院内感染的危险因素。方法：回顾性分析NICU 145例发生院内感染患儿的临床资料。结果：145例院内感染患儿中，肺炎克雷伯杆菌感染41例（28.3%)，大肠埃希菌感染39例（26.9%），表皮葡萄球菌感染10例（6.9%），其他病原感染55例（37.9%）。Logistic回归分析显示胎龄≤ 32周、出生体重<1500 g、住院时间、机械通气和肠外营养是肺炎克雷伯杆菌所致院内感染的主要危险因素（OR值分别为5.57、6.95、1.23、14.12、3.01）；这5个因素也是大肠埃希菌所致院内感染的主要危险因素（OR值分别为3.42、6.73、9.96、0.55、2.13）。肺炎克雷伯杆菌和大肠埃希菌对β-内酰胺类抗生素有较高的耐药率，而对左氧氟沙星、美洛培南则比较敏感。结论：肺炎克雷伯杆菌、大肠埃希菌及表皮葡萄球菌是NICU患儿院内感染的主要病原菌，它们对β-内酰胺类抗生素耐药率高。机械通气和住院时间分别是院内肺炎克雷伯杆菌和大肠埃希菌感染影响最大的危险因素。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	杨玲蓉
	彭珉娟
	李桦
	庞毅

关键词 ：重症监护室, 肺炎克雷伯杆菌, 大肠埃希菌, 院内感染, 新生儿

Abstract：OBJECTIVE: To study the pathogen distribution and risk factors of nosocomial infections in neonates in the neonatal intensive care units (NICU). METHODS: The clinical data of 145 neonates with nosocomial infection in the NICU were retrospectively reviewed. RESULTS: Of the 145 neonates, 41 (28.3%) were infected with Klebsiella pneumoniae, 39 (26.9%) with Escherichia coli, 10 (6.9%) with Staphylococcus epidermidis, and 55 (37.9%) with other pathogens. Logistic regression analysis showed that a gestational age of ≤32 weeks (OR=5.57), birth weigh of <1500 g (OR=6.95), hospitalization time (OR=1.23), mechanical ventilation (OR=14.12) and parenteral nutrition (OR=3.01) were major risk factors for nosocomial infections caused by Klebsiella pneumoniae. The five factors were also main risk factors for nosocomial infection caused by Escherichia coli, with the OR of 3.42, 6.73, 9.96, 0.55 and 2.13 respectively. Klebsiella pneumoniae and Escherichia coli were highly resistant to β-lactam antibiotics but were relatively sensitive to levofloxacin and meropenem. CONCLUSIONS: Klebsiella pneumoniae, Escherichia coli and Staphylococcus epidermidis are major pathogens of nosocomial infections in neonates in the NICU and they are resistant to β-lactam antibiotics. Mechanical ventilation and hospitalization time are the most important risk factors for nosocomial infections caused by Klebsiella pneumoniae and Escherichia coli respectively.

Key words： Intensive care unit Klebsiella pneumonia Escherichia coli Nosocomial infection Neonate

引用本文:

杨玲蓉,彭珉娟,李桦等. 新生儿重症监护室患儿院内感染病原菌分布及院内感染的危险因素分析[J]. 中国当代儿科杂志, 2013, 15(2): 112-116.

YANG Ling-Rong,PENG Min-Juan,LI Hua et al. Pathogen distribution and risk factors of nosocomial infections in neonates in the neonatal intensive care unit[J]. CJCP, 2013, 15(2): 112-116.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2013.02.010 或 http://www.zgddek.com/CN/Y2013/V15/I2/112

	［1］Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review［J］. Bull World Health Organ, 2011, 89(10): 757-765.
	［2］Combes A, Luyt CE, Trouillet JL, Nieszkowska A, Chastre J. Gender impact on the outcomes of critically ill patients with nosocomial infections［J］. Crit Care Med, 2009, 37(9): 2506-2511.
	［3］Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries［J］. Lancet, 2005, 365(9465): 1175-1188.
	［4］Garcia-Hernandez AM, Garcia-Vazquez E, Hernandez-Torres A, Ruiz J, Yague G, Herrero JA, et al. Bacteraemia due to Escherichia coli producing extended-spectrum beta-lactamases (ESBL): clinical relevance and today′s insights［J］. Rev Esp Quimioter, 2011, 24(2): 57-66.
	［5］Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988［J］. Am J Infect Control, 1988,16(3): 128-140.
	［6］Ahmad TA, El-Sayed LH, Haroun M, Hussein AA, El Ashry el SH. Development of immunization trials against klebsiella pneumoniae［J］. Vaccine, 2012, 30(14): 2411-2420.
	［7］Fernández Jonusas S, Brener Dik P, Mariani G, Fustinana C, Marco Del Pont J. Nosocomial infections in a neonatal unit: surveillance program［J］. Arch Argent Pediatr, 2011, 109(5): 398-405.
	［8］Amazian K, Rossello J, Castella A, Sekkat S, Terzaki S, Dhidah L, et al. Prevalence of nosocomial infections in 27 hospitals in the Mediterranean region［J］. East Mediterr Health J, 2010 16(10):1070-1078.
	［9］Yapicioglu H, Ozcan K, Sertdemir Y, Mutlu B, Satar M, Narli N, et al. Healthcare-associated infections in a neonatal intensive care unit in turkey in 2008: incidence and risk factors, a prospective study［J］. J Trop Pediatr, 2011, 57(3): 157-164.
	［10］Gupta A, Agrawal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia［J］. Indian J Crit Care Med, 2011, 15(2): 96-101.
	［11］Ghorashi Z, Nezami N, Hoseinpour-Feizi H, Ghorashi S, Tabrizi JS. Arthritis, osteomyelitis, septicemia and meningitis caused by klebsiella in a low-birth-weight newborn: a case report［J］. J Med Case Rep, 2011, 5: 241.
	［12］Mushtag S, Irfan S, Sarma JB, Doumith M, Pike R, Pitout J, et al. Phylogenetic diversity of Escherichia coli strains producing NDM-type carbapenemases［J］. J Antimicrob Chemother, 2011, 66(9):2002-2005.
	［13］Papadimitriou M, Voulgari E, Ranellou K, Koemtzidou E, Lebessi E, Tsakris A. Emergence of vim-1 metallo-β-lactamase-producing Escherichia coli in a neonatal intensive care unit［J］. Microb Drug Resist, 2011, 17(1): 105-108.
	［14］Wu D, Cai J, Liu J. Risk factors for the acquisition of nosocomial infection with carbapenem-resistant Klebsiella pneumoniae［J］. South Med J, 2011, 104(2): 106-110.