The Relativity Of Prophylactic Use Antibiotics And Nosocomial Infection And Risk Factors In Premature Infants

In recent years,the survival rate of premature infants has been significantlyincreased while the neonatal treatment gradually improved,in the sametime,people has paid more and more attention to nosocomial infection,infectious disease has been one of the most common causes of death in infantsof NICU.Preterm infants is a special group,because of the immaturity of organdevelopment,poor function of immune system,more chances to receive invasiveprocedures,and long hospital stay and etc,the incidence of nosocomial infectionin preterm infants is high,therefore,prophylactic use of antibiotics in preterminfants has been paying more attentions among domestic and foreignexperts.Some scholars pointed out that prophylactic use of antibiotics inpreterm infants after born can decrease the incidence of nosocomial infection,while other scholars hold the different point. This paper analysis the relativitybetween prophylactic use of antibiotics and nosocomial infection in preterminfants and analyse12dubious risk factor of nosocomial infection in preterminfants,further clarify whether the prophylactic use of antibiotics have aprotective effect of nosocomial infection in preterm infants and confirm the riskfactors of nosocomial infection in preterm infants,aim at playing a guiding roleon the clinical application of antibiotics in preterm infants.A historical cohortstudy conducted in the neonatal intensive care unit of First Hospital of JiLinUniversity,between1stJanuary in2009and31thDecember in2011.Retrospectively collect409cases,according to the occurrence of nosocomialinfections,the sample is divided into two groups,the infection group1（occurrence of nosocomial infections）and uninfection group2（non-occurrencof nosocomial infection）.Prophylactic used of antibiotics within48h after birth is considered to be dubious protective factor,while gestational age,birthweight,time of starting IG feeding,MV,PICC,Intra-Arterial Transcathter,time ofhospital stay and etc.are considered to be dubious risk factors,use χ2test andlogistic regression to analysis the risk factors of nosocomial infection and clearthe correlation between prophylactic use of antibiotics and nosocomialinfections in preterm infants.The results show that：1、χ2test shows that the riskfactors for nosocomial infections in preterm infants in the2groups are asfollowed:GA≤32w,BW≤1500g,starting IG feeding more than5days afterbirth,MV,PICC,Intra-Arterial Transcathter,time of hospital stay>2w,prophylactic use of antibiotics have statistically significance with nosocomialinfection;2、logistic regression analysis shows that only GA≤32w（P=0.031,OR=1.738）,BW≤1500g（P=0.032,OR=1.849）and time of hospital stay>2w（P=0.000,OR=6.446）are independent risk factors for nosocomial infections,the incidence of nosocomial infection is reduced with GA and BWincreased,prophylactic use of antibiotics is not the protective factor ofnosocomial infection （P=0.91,OR=1.029）;3、 In the409cases rate ofnosocomial infection occurrence is46.7%(191/409), among which pneumoniais the top one;4、Overall27pathogen were distributed, Klebsiella pneumoniaeis the main bacterium,Candida albicans is the main epiphyte.Conclusion:1.prophylactic use of antibiotics is have no protective effect on nosocomialinfection;2.Significant correlations between nosocomial infection and thefollowing factors:GA≤32w,BW≤1500g,starting IG feeding more than5daysafter birth,MV,PICC,Intra-Arterial Transcathter,time of hospital stay>2w,prophylactic use of antibiotics are risk factors of nosocomial infection ofpreterm infants;3.GA≤32w、BW≤1500g and time of hospital stay>2W arethe independent risk factors of nosocomial infection, the incidence ofnosocomial infection is reduced with GA and BW increased;4. strengthening the perinatal period careand reasonable use of antibiotics are the effectivemeasures to prevent nosocomial infection.