上海某三级综合医院新生儿病房患者入院时细菌主动筛查分析

Active bacterial screening among patients during admission to the neonatal ward of a tertiary hospital in Shanghai

摘要:

目的 了解新生儿入院时咽、脐部细菌检出及耐药情况, 为新生儿感染防控提供依据。 方法 回顾性收集某院新生儿病房2017—2022年3 639例新生儿入院主动筛查的监测结果, 对比分析2017—2019年新型冠状病毒感染疫情前三年和2020—2022年新型冠状病毒感染疫情三年的细菌检出变化。 结果 2017—2022年共调查新生儿3 639例, 914例新生儿检出细菌1 152株, 排名前5位的细菌依次为大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌、肺炎克雷伯菌, 前后三年前三位细菌排名不同, 脐部细菌检出阳性率均高于咽部, 差异均有统计学意义(均P＜0.001)。多重耐药菌检出以耐甲氧西林金黄色葡萄球菌(MRSA)为主(71株)。新型冠状病毒疫情三年金黄色葡萄球菌、MRSA检出阳性率较前三年降低(分别为2.79% VS 4.76%、0.63% VS 1.31%), 差异均有统计学意义(均P＜0.05)。前三年脐部MRSA阳性率(2.25%)高于咽部(0.38%); 脐部MRSA阳性率疫情三年(0.61%)较前三年降低(2.25%); 差异均有统计学意义(均P＜0.001)。疫情三年新生儿病房住院新生儿抗菌药物使用率为60.89%, 低于前三年的67.42%, 差异有统计学意义(P＜0.001)。 结论 新型冠状病毒感染疫情期间新生儿入院筛查金黄色葡萄球菌以及脐部MRSA检出阳性率较疫情前降低, 可能与疫情期间医院内外全民公共卫生行为意识增强有关。

Abstract:

Objective To understand the detection and antimicrobial resistance of bacteria in the pharynx and umbilicus of neonates during admission to hospital, and provide basis for the prevention and control of neonatal infection. Methods Active screening results of 3 639 neonates admitted to the neonatal ward of a hospital from 2017 to 2022 were retrospectively investigated. Changes in bacterial detection in the three years (2017-2019) before COVID -19 pandemic and the three years (2020-2022) during COVID -19 pandemic were compared and analyzed. Results From 2017 to 2022, a total of 3 639 neonates were investigated, and 1 152 strains were detected from 914 neonates. The top 5 detected bacteria were Escherichia coli, Staphylococcus aureus, coagulase negative Staphylococcus, Enterococcus faecalis, and Klebsiella pneumoniae. The top 3 bacteria detected in the three years before the pandemic were different from that during the pandemic, and the positive rate of bacteria detected in umbilicus was higher than that in pharynx, with statistically significant differances (P < 0.001). The major multidrug-resistant organism was methicillin-resistant Staphylococcus aureus (MRSA) (n=71). The positive detection rates of Staphylococcus aureus and MRSA in the three years during COVID -19 epidemic were both significantly lower than that before the pandemic (2.79% vs 4.76%; 0.63% vs 1.31%, respectively, both P < 0.05). The positive rate of MRSA in umbilicus was higher than that in pharynx (2.25% vs 0.38%) in the three years before pandemic. The positive detection rate of MRSA in umbilicus in the three years during the epidemic decreased compared to before the pandemic (0.61% vs 2.25%)(P < 0.001). Antimicrobial usage rate of hospitalized patients from the neonatal ward in the three years during the epidemic was lower than that before the pandemic (60.89% vs 67.42%, P < 0.001). Conclusion The positive rates of Staphylococcus aureus and MRSA detected in umbilical via neonatal screening were lower during the COVID -19 epidemic than that before the pandemic, which may be related to the increased awareness of public health behaviors in and outside hospitals during the epidemic.