| 向 敏,王 鉴,黄 康,杨 阳,罗光英.新生儿重症监护室中极低和超低出生体重早产儿院内感染影响因素及病原菌分布变化的分析[J].,2024,(12):2302-2305 |
| 新生儿重症监护室中极低和超低出生体重早产儿院内感染影响因素及病原菌分布变化的分析 |
| Analysis of Factors Influencing Nosocomial Infection and Pathogenic Bacteria Distribution in Very Low And Ultra-low Birth Weight Premature Infants in Neonatal Intensive Care Unit |
| 投稿时间：2023-10-08 修订日期：2023-10-31 |
| DOI：10.13241/j.cnki.pmb.2024.12.019 |
| 中文关键词: 新生儿重症监护室 极低出生体重早产儿 超低出生体重早产儿 院内感染 影响因素 病原菌 |
| 英文关键词: Neonatal intensive care unit Very low birth weight premature infants Ultra-low birth weight premature infants Hospital infection Influencing factors Pathogenic bacteria |
| 基金项目:贵州省科技厅计划项目（黔科合基础-ZK[2023]一般350） |
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| 中文摘要: |
| 摘要 目的：分析新生儿重症监护室中极低和超低出生体重早产儿院内感染影响因素及病原菌分布变化情况。方法：选择2018年1月至2022年12月收治的493例极低和超低出生体重早产儿，根据是否发生院内感染，分为感染组（54例)与非感染组（439例）。比较两组新生儿的临床特征，使用多因素Logistic回归分析院内感染的影响因素，分析院内感染病原菌的分布及早期临床特点。结果：两组胎龄、出生体重、宫内窘迫占比、先天性心脏病占比、肠外营养持续时间＞14 d的占比、机械通气时间＞24 h的占比、PICC置管时间＞14 d的占比、住院时间比较（P＜0.05）；经多因素Logistic回归分析，肠外营养持续时间＞14 d、机械通气时间＞24 h、PICC置管时间＞14 d均是早产儿发生院内感染的独立危险因素（P＜0.05）；在54例院内感染患儿中，共培养出病原菌41株，其中革兰阳性菌10株，以表皮葡萄球菌为主；革兰阴性菌24株，以肺炎克雷伯杆菌为主；真菌7株，以白色假丝酵母菌为主；革兰阳性菌组、革兰阴性菌组与真菌组在胎龄、出生体重、反应低下、发热、消化系统症状、血小板减少、血氧下降或呼吸暂停上差异均无统计学意义（P＞0.05）。结论：新生儿重症监护室中极低和超低出生体重早产儿院内感染与肠外营养持续时间、机械通气时间和PICC置管时间密切相关，病原菌以表皮葡萄球菌、肺炎克雷伯杆菌和白色假丝酵母菌为主，早期临床特点缺乏特异性，可作为防治院内感染的重要依据。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the influential factors of nosocomial infection and the distribution of pathogenic bacteria in very low and ultra-low birth weight premature infants in neonatal intensive care unit. Methods: 493 very low and ultra-low birth weight premature infants from January 2018 to December 2022 were selected. According to whether nosocomial infection occurred, they were divided into infected group (54 cases) and non-infected group (439 cases). The clinical characteristics of the two groups were compared,and the influencing factors of nosocomial infection were analyzed by multi-factor Logistic regression, and the distribution of pathogenic bacteria and early clinical characteristics of nosocomial infection were analyzed. Results: There were differences in gestational age, birth weight, intrauterine distress, congenital heart disease, parenteral nutrition duration>14 d, mechanical ventilation duration>24 h, PICC catheter duration>14 d and hospital stay between the two groups (P<0.05). Multivariate Logistic regression analysis showed that the duration of parenteral nutrition>14 days, the duration of mechanical ventilation>24 hours, and the duration of PICC catheter>14 days were all independent risk factors for nosocomial infection in birth weight infants in NICU(P<0.05). In 54 children with nosocomial infection, 41 strains of pathogenic bacteria were cultured, including 10 strains of gram-positive bacteria, mainly Staphylococcus epidermidis. There were 24 gram-negative strains, mainly Klebsiella pneumoniae. There were 7 strains of fungi, mainly Candida albicans. There were no differences in gestational age, birth weight, hyporeactivity, fever, digestive symptoms, thrombocytopenia, hypoxia or apnea between gram-positive bacteria group, gram-negative bacteria group and fungus group (P>0.05). Conclusion: Nosocomial infection of very low and ultra-low birth weight premature infants in neonatal intensive care unit is closely related to the duration of parenteral nutrition,mechanical ventilation time and PICC insertion time, staphylococcus epidermidis, klebsiella pneumoniae and candida albicans are the main pathogens, and the early clinical characteristics lack specificity, which can be used as an important basis for prevention and treatment of nosocomial infection. |
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