Abstract：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.
ZHANG De-Shuang,XIE Dong-Ke,HE Na et al. Pathogen distribution, risk factors, and outcomes of nosocomial infection in very premature infants[J]. CJCP, 2017, 19(8): 866-871.
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.
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.
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.
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.
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.
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.
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.
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.
