目的 探讨极低出生体重儿(VLBWI,包括超低出生体重儿)医院感染情况及危险因素.方法 回顾性调查某院2008年1月-2010年1月新生儿重症监护室(NICU)收治的出生体重＜1 500 g、住院时间＞48 h的VLBWI相关资料.结果 77例VLBWI发生医院感染18例,29例次,医院感染率为23.38％,例次感染率为37.66％;感染部位以呼吸道为主(55.17％),其次为皮肤软组织(17.24％)和血液(13.79％);共检出病原菌34株,革兰阴性杆菌占67.64％(23株),以肺炎克雷伯菌多见,其次为大肠埃希菌;革兰阳性菌占14.71％(5株);真菌占17.65％(6株),主要为白假丝酵母菌.单因素分析结果显示,胎龄、出生体重、机械通气时间、胎膜早破及静脉营养为有统计学意义的因素(P＜0.05);多元logistic回归显示,出生体重＜1 kg(OR 95％ CI:1.65～90.95)、机械通气时间＞7 d(OR 95％ CI:2.71～129.15)、静脉营养＞14 d(OR 95％ CI:1.83～76.52)是VLBWI发生医院感染的独立危险因素.结论 VLBWI医院感染发生率高,危险因素多;呼吸道是其主要感染部位,革兰阴性杆菌是主要病原菌,真菌感染需引起重视.%Objective To evaluate the occurrence and risk factors of healthcare-associated infection (HAI) in very low birth weight infants (VLBWI,including extremely low birth weight infants).Methods Data of VLBWI (birth weight ＜1 500 g,length of hospital stay ＞48 hours)in a neonatal intensive care unit(NICU) from January 2008 to January 2010 were analyzed retrospectively.Results Of 77 VLBWI,18 developed 29 times of HAI,HAI rate was 23.38％,HAI case rate was 37.66％; the main infection site was respiratory tract (55.17％),followed by skin and soft tissue (17.24％) and blood stream (13.79％); a total of 34 pathogenic isolates were isolated,67.64％ (23 isolates)were gram-negative bacilli,the most common pathogens were Klebsiella pneumoniae and Escherichia coli;14.71％ (5 isolates) were gram-positive bacteria; 17.65％ (6 isolates) were fungi,the main fungus was Candida albicans.Univariate analysis indicated that gestational age,birth weight,mechanical ventilation,premature rupture of fetal membrane,and parenteral nutrition were risk factors for HAI(P＜0.05) ; multivariate logistic regression analysis showed that birth weight ＜1 kg(OR 95％ CI:1.65-90.95),mechanical ventilation＞7 d(OR 95％ CI:2.71-129.15),and duration of parenteral nutrition＞14 d(OR 95％ CI:1.83-76.52) were independent risk factors for HAI Conclusion The incidence of HAI in VLBWI is high and risk factor is multiple.Respiratory tract is the main infection site,gram-negative bacillus is the most frequently isolated pathogen,more attention should be paid to fungal infection.
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