PDF(1254 KB)
PDF(1254 KB)
PDF(1254 KB)
极早产儿医院内感染的病原分布及其危险因素和结局分析
Pathogen distribution, risk factors, and outcomes of nosocomial infection in very premature infants
目的 分析我院极早产儿医院内感染的病原分布，探讨其可能的危险因素及不良结局的发生风险。方法 回顾性分析2016年1~12月出生，胎龄< 32周且出生体重< 1 500 g的111例极早产儿的临床资料。根据住院≥72 h后是否发生医院内感染分为感染组与未感染组，分析感染组患儿所感染的病原菌及其药敏情况；采用多因素logistic回归分析极早产儿发生医院内感染的潜在危险因素及不良结局的发生风险。结果 极早产儿发生医院内感染的主要致病菌为革兰阴性菌，占54%，以铜绿假单胞菌最为常见；其次为真菌（41%），以白色念珠菌最为多见。药敏试验显示：革兰阴性菌对β-内酰胺类及碳青霉烯类均有较高耐药性，对喹诺酮类具有较高敏感性；真菌对伊曲康唑敏感性较低，对5-氟胞嘧啶和两性霉素B具有较高敏感性。早发败血症、外周静脉穿刺中心静脉置管（PICC）时间、激素暴露、肠外营养时间为极早产儿医院内感染的危险因素（P < 0.05）。感染组早产儿肺部并发症的发生风险高于未感染组（P < 0.05）。与未感染组比较，感染组患儿住院时间延长，住院费用增加（P < 0.001）。结论 极早产儿医院内感染受多重因素影响，增加其不良预后的发生风险。临床应结合药物敏感分析，采取合理防治措施，改善极早产儿的预后。
Objective To study the pathogen distribution and risk factors of nosocomial infection in very preterm infants, as well as the risk of adverse outcomes.Methods A retrospective analysis was performed for the clinical data of 111 very preterm infants who were born between January and December, 2016 and had a gestational age of < 32 weeks and a birth weight of < 1 500 g. According to the presence or absence of nosocomial infection after 72 hours of hospitalization, the infants were divided into infection group and non-infection group. The infection group was analyzed in terms of pathogenic bacteria which caused infection and their drug sensitivity. A multivariate logistic regression analysis was used to investigate the potential risk factors and risk of adverse outcomes of nosocomial infection in very preterm infants.Results Gram-negative bacteria were the main pathogens for nosocomial infection in very preterm infants and accounted for 54%, among which Pseudomonas aeruginosa was the most common one; the following pathogens were fungi (41%), among which Candida albicans was the most common one. The drug sensitivity test showed that Gram-negative bacteria were highly resistant to β-lactam and carbapenems and highly sensitive to quinolones, while fungi had low sensitivity to itraconazole and high sensitivity to 5-fluorocytosine and amphotericin B. Early-onset sepsis, duration of peripherally inserted central catheter, steroid exposure, and duration of parenteral nutrition were risk factors for nosocomial infection in very preterm infants (P < 0.05). Compared with the non-infection group, the infection group had significantly higher risks of pulmonary complications (P < 0.05), as well as a significantly longer length of hospital stay and a significantly higher hospital cost (P < 0.001).Conclusions Nosocomial infection in very preterm infants is affected by various factors and may increase the risk of adverse outcomes. In clinical practice, reasonable preventive and treatment measures should be taken with reference to drug sensitivity, in order to improve the prognosis of very premature infants.
Nosocomial infection / Pathogenic bacteria / Risk factor / Prognosis / Preterm infant
[1] 麦菁芸, 董琳, 林振浪, 等. 新生儿医院感染的调查分析[J]. 中华儿科杂志, 2011, 49 (12): 915-920.
[2] Polin RA, Denson S, Brady MT, et al. Epidemiology and diagnosis of health care-associated infections in the NICU[J]. Pediatrics, 2012, 129 (4): e1104-e1109.
[3] Haller S, Deindl P, Cassini A, et al. Neurological sequelae of healthcare-associated sepsis in very-low-birthweight infants: umbrella review and evidence-based outcome tree[J]. Euro Surveill, 2016, 21 (8): 30143.
[4] Lapcharoensap W, Kan P, Powers RJ, et al. The relationship of nosocomial infection reduction to changes in neonatal intensive care unit rates of bronchopulmonary dysplasia[J]. J Pediatr, 2017, 180: 105-109.e1.
[5] 中华人民共和国卫生部. 医院感染诊断标准 (试行) [J]. 中华医学杂志, 2001, 81 (5): 314-320.
[6] 中华人民共和国卫生部. 中华人民共和国卫生行业标准 医院感染监测规范[J]. 中华医院感染学杂志, 2009, 19 (11): 1-2.
[7] International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited[J]. Arch Ophthalmol, 2005, 123 (7): 991-999.
[8] 常立文. 支气管肺发育不良[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京:人民卫生出版社, 2011: 416-422.
[9] 周丛乐. 早产儿脑白质损伤[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京: 人民卫生出版社, 2011: 715-723.
[10] 周丛乐. 颅内出血[M]//邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学. 第4版. 北京: 人民卫生出版社, 2011: 706-715.
[11] Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100 (3): F257-F263.
[12] Zafar N, Wallace CM, Kieffer P, et al. Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate[J]. Arch Pediatr Adolesc Med, 2001, 155 (10): 1098-1104.
[13] Yuan Y, Zhou W, Rong X, et al. Incidence and factors associated with nosocomial infections in a neonatal intensive care unit (NICU) of an urban children's hospital in China[J]. Clin Exp Obstet Gynecol, 2015, 42 (5): 619-628.
[14] Abdel-Wahab F, Ghoneim M, Khashaba M, et al. Nosocomial infection surveillance in an Egyptian neonatal intensive care unit[J]. J Hosp Infect, 2013, 83 (3): 196-199.
[15] Gadallah MA, Aboul Fotouh AM, Habil IS, et al. Surveillance of health care-associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up[J]. Am J Infect Control, 2014, 42 (11): 1207-1211.
[16] 姜娜, 汪盈, 王琦, 等. 超早产儿医院感染及其危险因素分析[J]. 中华儿科杂志, 2014, 52 (2): 137-141.
[17] Stoll B, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network[J]. Pediatrics, 2002, 110 (2 Pt 1): 285- 291.
[18] García H, Torres-Gutiérrez J, Peregrino-Bejarano L, et al. Risk factors for nosocomial infection in a level Ⅲ Neonatal Intensive Care Unit[J]. Gac Med Mex, 2015, 151 (6): 711-719.
[19] 刘菊敏, 鲁芹, 亓立红, 等. 早产儿医院感染病原菌分布与耐药性分析[J]. 中华医院感染学杂志, 2015, 25 (10): 2351-2353.
[20] Gill AW. Analysis of neonatal nosocomial infection rates across the Australian and New Zealand Neonatal Network[J]. J Hosp Infect, 2009, 72 (2): 155-162.
[21] Bowen JR, Callander I, Richards R, et al. Decreasing infection in neonatal intensive care units through quality improvement[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102 (1): F51- F57.
[22] Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care- associated infection in developing countries: systematic review and meta-analysis[J]. Lancet, 2011, 377 (9761): 228-241.
[23] Brito DV, Brito CS, Resende DS, et al. Nosocomial infections in a Brazilian neonatal intensive care unit: a 4-year surveillance study[J]. Rev Soc Bras Med Trop, 2010, 43 (6): 633-637.
[24] Urzedo JE, Levenhagen MM, Pedroso RS, et al. Nosocomial infections in a neonatal intensive care unit during 16 years: 1997-2012[J]. Rev Soc Bras Med Trop, 2014, 47 (3): 321-326.
[25] 花少栋, 黄捷婷, 吴志新, 等. 早产儿真菌败血症: 附37例报告[J]. 中国小儿急救医学, 2013, 20 (2): 177-180.
[26] 徐豆豆, 王杨, 藏建业, 等. 新生儿重症监护病房内早产儿真菌脓毒症危险因素临床分析: 2010年至2012年单中心报告[J]. 中华实用儿科临床杂志, 2013, 28 (18): 1393-1397.
[27] Bonfietti LX, Szeszs MW, Chang MR, et al. Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital[J]. Mycopathologia, 2012, 174 (5-6): 389-396.
[28] Leibovitz E. Strategies for the prevention of neonatal candidiasis[J]. Pediatr Neonatol, 2012, 53 (2): 83-89.
[29] Wisplinghoff H, Ebbers J, Geurtz L, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities[J]. Int J Antimicrob Agents, 2014, 43 (1): 78-81.
[30] 曹云. 新生儿重症监护病房真菌感染防治进展[J]. 中国新生儿科杂志, 2012, 27 (6): 365-368.
[31] 花少栋, 吴志新, 黄捷婷, 等. 早产儿白假丝酵母菌败血症13例临床分析[J]. 中国当代儿科杂志, 2012, 14 (10): 728-732.
[32] Arrieta AC, Shea K, Dhar V, et al. Once-weekly liposomal amphotericin B as Candida prophylaxis in very low birth weight premature infants: a prospective, randomized, open-label, placebo-controlled pilot study[J]. Clin Ther, 2010, 32 (2): 265-271.
[33] 迟春昕, 谢巧庆, 林俊. NICU早产儿医院感染危险因素分析及对策[J]. 中华医院感染学杂志, 2014, 24 (5): 1268-1272.
[34] 杨玲蓉, 彭珉娟, 李桦, 等. 新生儿重症监护室患儿医院内感染病原菌分布及医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.
[35] Njere I, Islam S, Parish D, et al. Outcome of peripherally inserted central venous catheters in surgical and medical neonates[J]. J Pediatr Surg, 2011, 46 (5): 946-950.
[36] Anday EK, Conway D. Steroid therapy in the high-risk neonate: benefits and risks[J]. Clin Obstet Gynecol, 2003, 46 (1): 190-210.
[37] Mitha A, Foix-L'Hélias L, Arnaud C, et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants[J]. Pediatrics, 2013, 132 (2): e372-e380.
[38] Schlapbach LJ, Aebischer M, Adams M, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants[J]. Pediatrics, 2011, 128 (2): e348-e357.
[39] Alshaikh B, Yusuf K, Sauve R. Neurodevelopmental outcomes of very low birth weight infants with neonatal sepsis: systematic review and meta-analysis[J]. J Perinatol, 2013, 33 (7): 558-564.
[40] Jantzen C, Lodha A, Lucia M, et al. Effects of nosocomial infection trends on neonatal outcomes in preterm infants < 33 weeks of gestational age in Canadian NICUs[J]. 中国当代儿科杂志, 2015, 17 (10): 1019-1027.
