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首页> 外文期刊>Journal of Pediatric Surgery: Official Journal of the Surgical Section of the American Academy of Pediatric, the British Association of Paediatric Surgeons, the American Pediatric Surgical Association, and the Canadian Association of Paediatric Surgeons >Classification and risk-factor analysis of infections in a surgical neonatal unit.
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Classification and risk-factor analysis of infections in a surgical neonatal unit.

机译：新生儿外科手术感染的分类和危险因素分析。

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BACKGROUND/PURPOSE: Nosocomial infection may result in significant morbidity in surgical neonates. Traditionally, nosocomial infections are classified using time cut-off points. Gastrointestinal carriage of microorganisms has not been used as a criterion for classifying infection in surgical neonates. The aims of the study were to (1) determine the overall infection rate, (2) distinguish between nosocomial and community acquired infections using a 48-hour postadmission cutoff and the carrier state criterion, and (3) determine risk factors for clinical infection. METHODS: A 1-year prospective observational cohort study was undertaken in a regional neonatal surgical unit between 1997 and 1998. All infants residing for >/=3 days in the unit were included in the study (n = 167). Patient demographics, including illness severity (PRISM score), were recorded for all infants. Surveillance throat and rectal swabs were obtained on admission and twice weekly thereafter to determine carrier status. Carriage was defined as isolation of the same microorganism from at least 2 consecutive surveillance samples. Infective episodes were diagnosed if a clinical diagnosis of local or general inflammation was microbiologically proven. RESULTS: A total of 167 infants responsible for 174 admissions were studied. Median gestational age was 38 weeks (range, 24 to 42), median birth weight was 3 kg (range, 1 to 3.6), median age on admission was 8 days (range, 0 to 142), median length of hospital stay was 8 days (range, 3 to 95). The diagnoses were gastrointestinal disorders (n = 96), abdominal wall defects (n = 22), neural tube defects and hydrocephalus (n = 17), thoracic disorders (n = 16), urologic disorders (n = 12), and abdominal tumours (n = 4). Twenty-five infants had 33 episodes of infection giving an overall infection rate of 14.9%. The predominant infecting organism was Stapylococcus aureus (n = 11); others were enterococcus, coagulase negative staphylococcus, Candida spp, Gram-negative bacilli, and anaerobes. A total of 27 of 33 infective episodes were caused by microorganisms carried by the infants on admission (primary endogenous). Only 6 children had "true" nosocomial infections. Using a traditional 48 hour cutoff, 87% of the infections were classed as nosocomial. Birth weight, presence of central venous line, PRISM score, and length of stay were identified as significant risk factors for developing clinical infection. CONCLUSIONS: (1) Carriage allowed us to identify the true nosocomial infection rate (microorganisms acquired in the unit), which was only 18%. In contrast, using a traditional 48 hour cutoff, 87% of the infections would have been classed as nosocomial and warranted unnecessary cross-infection investigations. (2) The results of this study confirm that birth weight, illness severity (PRISM score), presence of central venous catheter, and length of hospital stay were independent risk factors associated with clinical infection in surgical neonates.
机译：背景/目的：医院感染可能导致外科新生儿的严重发病。传统上，医院感染是使用时间截止点进行分类的。微生物的胃肠道运输尚未用作对外科新生儿进行感染分类的标准。该研究的目的是（1）确定总体感染率，（2）使用入院后48小时截止和携带者状况标准区分医院感染和社区获得性感染，以及（3）确定临床感染的危险因素。方法：在1997年至1998年之间，在一个区域新生儿外科单元中进行了为期1年的前瞻性观察队列研究。该单元中所有居住> / = 3天的婴儿都纳入了研究（n = 167）。记录所有婴儿的患者人口统计资料，包括疾病严重程度（PRISM评分）。入院时监测喉咙和直肠拭子，此后每周两次，以确定携带者的状况。支架定义为从至少两个连续的监测样品中分离出同一微生物。如果在微生物学上证明了局部或一般炎症的临床诊断，则可以诊断为感染性发作。结果：总共对167名婴儿进行了174例入院的研究。胎龄中位数为38周（范围为24至42），出生体重中位数为3 kg（范围为1至3.6），入院年龄中位数为8天（范围为0至142），住院时间中位数为8天（范围为3到95）。诊断为胃肠道疾病（n = 96），腹壁缺损（n = 22），神经管缺损和脑积水（n = 17），胸椎疾病（n = 16），泌尿科疾病（n = 12）和腹部肿瘤（n = 4）。 25例婴儿发生了33次感染，总感染率为14.9％。主要的感染生物是金黄色葡萄球菌（n = 11）。其他是肠球菌，凝固酶阴性葡萄球菌，念珠菌，革兰氏阴性杆菌和厌氧菌。 33例传染病中，共有27例是由婴儿在入院时携带的微生物引起的（原发性内源性）。只有6个孩子患有“真正的”医院感染。使用传统的48小时截止，将87％的感染归为医院感染。出生体重，中心静脉线的存在，PRISM评分和住院时间被确定为发生临床感染的重要危险因素。结论：（1）运输使我们能够确定真正的医院感染率（单位中获得的微生物），仅为18％。相比之下，使用传统的48小时临界值，则87％的感染会被归类为医院感染，因此需要进行不必要的交叉感染调查。 （2）这项研究的结果证实，出生体重，疾病严重程度（PRISM评分），中心静脉导管的存在以及住院时间是与手术新生儿临床感染相关的独立危险因素。

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