不同胎龄不同体重新生儿医院感染的流行病学及临床特点

Epidemiological and clinical characteristics of healthcare-associated infection in neonates with different gestational ages and birth weights

摘要:

目的 了解不同胎龄、不同体重新生儿医院感染的流行病学及临床特点,为临床个性化诊疗提供指导意见。方法 按照纳入与排除标准选取2018年1月—2022年12月邯郸市某医院新生儿重症监护病房(NICU)发生医院感染的240例新生儿作为研究组,按1 ∶3 的比例采用系统抽样法抽取720例非医院感染新生儿作为对照组,分析不同胎龄、不同体重新生儿医院感染发病率、感染部位分布特点、病原学特点,以及不同生产方式对不同胎龄、不同体重新生儿医院感染的影响。结果 胎龄＜28 W、体重＜1 000 g新生儿医院感染发病率最高,分别为19.48%、20.41%。胎龄＜28 W新生儿以不明部位感染最多见(占37.50%),28~36⁺⁶ W各胎龄层均以血液系统感染和呼吸系统感染为主,≥37 W的新生儿以血液系统感染和不明部位感染多见;各体重新生儿均以血液系统感染最常见,其次是呼吸系统。不同胎龄、不同体重新生儿不同部位感染的病原菌有所不同。在胎龄28~31⁺⁶ W和体重1 000~1 499 g的新生儿中,发生医院感染和未发生医院感染的新生儿相应的出生方式构成情况比较,差异均有统计学意义(均P＜0.05)。结论 不同胎龄、不同体重新生儿医院感染具有不同的流行病学及临床特点,医院感染防控工作中应针对不同个体制定特异性诊疗方案,精准防控,降低医院感染发病率,提高新生儿整体救治水平。

Abstract:

Objective To understand the epidemiological and clinical characteristics of healthcare-associated infection (HAI) in neonates with different gestational ages and birth weights, and provide guidance for personalized cli-nical diagnosis and treatment. Methods According to the inclusion and exclusion criteria, 240 neonates with HAI in the neonatal intensive care unit (NICU) of a hospital in Handan City from January 2018 to December 2022 were selected as the study group, 720 neonates without HAI were selected as the control group based on systematic sampling method with a ratio of 1 ∶3. The incidence of HAI , distribution characteristics of infection site, pathogenic features of HAI, as well as the effect of different delivery modes on HAI in neonates with different gestational ages and birth weights were analyzed. Results Neonates with gestational age <28 weeks and birth weight <1 000 g had the highest incidence of HAI, which were 19.48% and 20.41%, respectively. Among neonates with gestational age <28 weeks, unidentified site infection were the most (37.50%), while in all gestational age groups within 28-36⁺⁶ weeks, bloodstream infection (BSI) and respiratory system infection were predominant. For neonates with gestational age ≥37 weeks, BSI and unidentified site infection occurred frequently. Among neonates in all weight groups, BSI was the most frequent, followed by respiratory system infection. Pathogens from different sites of infections in neonates with different gestational ages and birth weights varied. Among neonates with gestational age of 28-31⁺⁶ weeks and birth weight of 1 000-1 499 g, the constituent of birth modes showed statistically significant difference between neonates with and without HAI (both P<0.05). Conclusion Epidemiological and clinical chara-cteristics of HAI in neonates with different gestational ages and birth weights are different. For the prevention and control of HAI, individualized diagnosis and treatment plans should be developed to achieve precise prevention and control, reduce the incidence of HAI, and improve the overall treatment level of neonates.