新生儿重症监护病房医院感染流行病学多中心研究

目的了解我国三级甲等综合医院新生儿监护病房(NICU)医院感染的流行特点,为预防和控制新生儿医院感染提供科学依据。方法以多中心研究的方式，选取全国9省17所医院，按照统一的诊断标准和方法对2013年10月—2014年9月NICU住院新生儿的医院感染情况进行前瞻性监测。结果共监测 12 998例NICU住院新生儿，发生436例次医院感染，例次发病率为3.35%，住院总日数为126 125 d，日发病率为3.46‰。新生儿医院感染例次发病率随新生儿出生体重的增加而下降（χ2=291.55，P＜0.001）。不同规模NICU新生儿医院感染发病率比较，差异有统计学意义（χ2=49.77，P＜0.001），床位数＞30张的NICU新生儿医院感染例次发病率和日发病率最高；NICU新生儿医院感染例次发病率以西南地区（10.36%）最高，日发病率以华南地区（10.52‰）最高。感染部位以下呼吸道和血液为主；感染病原体以肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌为主。结论我国NICU不同出生体重组、不同规模、不同地区的新生儿医院感染发病率不同，应继续加强监测，根据感染特点指导各项防控措施的落实。

Multicenter study on epidemiology of healthcare associated infection in neonatal intensive care units

ObjectiveTo investigate the epidemiological characteristics of healthcare associated infection (HAI) in neonatal intensive care units(NICUs) of tertiary first class hospitals in China, and provide scientific evidence for the prevention and control of neonatal HAI. Methods17 hospitals in 9 provinces were selected for multicenter study, HAI occurred in neonates at NICUs from October 2013 to September 2014 were surveyed prospectively according to the uniform diagnostic criteria and methods. ResultsA total of 12 998 neonates were monitored, 436 (3.35%) HAI cases occurred, the total patient days were 126 125 days, incidence of infection was 3.46/1 000 patient days. HAI cases rate decreased with the increase of birth weight (χ2=291.55, P＜0.001). The difference of HAI rate in neonates at different sizes of ICUs were significantly different(χ2=49.77, P＜0.001), infection case rate and infection incidence per 1 000 patient days were both highest in NICUs with ＞30 beds; HAI case rate was highest in southwest region(10.36%), infection rate per 1 000 patient days was the highest in southern China(10.52‰). Lower respiratory tract and bloodstream were the main infection sites; the major pathogens for infection were Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii.ConclusionThe incidences of HAI in NICUs are different among neonates of different birth weight, at different sizes of ICUs, and at ICUs of different regions, surveillance should be strengthened, prevention and control measures should implemented according to infection characteristics.