Clinical Analysis On Nosocomial Infections Of Preterm Infant In A Neonatal Intensive Care Unit

Objective1. To explore the Epidemiology of hospital infection in our hospital neonatalintensive care unit (NICU) preterm children for four years.2. To investigate thepremature children nosocomial infection risk factors,3. Investigate the situation ofantibiotic use four years in our hospital NICU.MethodsRetrospective study of clinical medical record information of2009-2011hospitalNICU admitted preterm children, the study included858preterm children,nosocomial infection diagnostic criteria refer to the3rd edition of "Practicalneonatology" standards developed,use the SPSS and Graphpad prism5statisticalsoftware for statistical analysis.Results1.111cases occurred139times of nosocomial infections,hospital infection rate was12.9%, inpatient hospital days and hospital infection incidence of16.2cases/100hospitalized patients,10.1cases/1000hospitalized patient day;179prematurechildren with mechanical ventilation,59cases of VAP, the total number of days ofmechanical ventilation1083days，ventilator-associated pneumonia (VAP) incidenceof54.5cases/1000day of mechanical ventilation,43premature children with PICC, 1case of central venous catheter-related sepsis (CRBSI),and CR-BSI incidence of2.2cases/1000central venous catheter day.2. Lung infection (43.9%) is the most common hospital infection, followed by sepsis(38.1%), and other common hospital infections skin infections (6.5%), thrush (5.0%),conjunctivitis (3.6%)gastrointestinal tract infection (2.2%) and peritonitis (0.7%).4-year period, a total of88pathogens were detected. Gram negative bacteria is themost, including Klebsiella pneumoniae,27(30.7%), hospital NICU prematurechildren the most common nosocomial infection pathogens, Klebsiella pneumoniaeinfection accounted for the proportion of nosocomial infection was significantlyhigher from2008and2009were11.8%,9.1%, jumped to21.7%in2010,20.5%in2011. Gram-negative bacteria infection in the hospital to ceftazidime, ceftriaxoneresistance rates were34/47(72%),30/38(79%), cefepime was31/47(66%); aminothe glycosides resistance rate of27%to55%; amoxicillin and clavulanate potassiumresistance rate of69%; piperacillin tazobactam resistance was33%;4-year period isnot found meropenem and imipenem-resistant Gram-negative bacteria.Klebsiella pneumoniae to ceftazidime, ceftriaxone, cefepime resistance rates were88%,100%,88%, the aminoglycoside resistance rate of14%to65%,of amikacin of50%, was not found to piperacillin tazobactam and carbapenem-resistant Klebsiellapneumoniae bacteria.3. The premature children hospital infection risk factors: gestational age <32weeks(OR=4.21,95%CI1.924-10.915,P=0.007),mechanicalventilation(OR=6.72,95%CI4.057-11.134,P<0.001), parenteralnutrition(OR=6.18,95%CI3.187-13.734,P<0.001), and early use ofantibiotics(OR=2.64,95%CI1.175-5.923,P=0.019) and third generationcephalosporin antibiotic use(OR=2.951,95%CI1.645-5.295,P<0.001).4.4years periods, the use of antibiotics, penicillin utilization rate reached63.8%to95.3%, but a declining trend (rs=0.098, p=0.005), second generationcephalosporins utilization rate volatility42.4%~75.0%, beta-lactamase/compound preparation stable utilization rate of16.7%to22.5%, the third generationcephalosporin usage between48.5%to74.9%, carbapenems fluctuations from10.5% to22.3%, with drug-resistant Gram-positive cocci and fungiinfection increase, theglycopeptide (rs=0.011, p=0.032), fluconazole (rs=0.021, p=0.004) andvoriconazole itraconazole (rs=0.027, p=0.001) usage showed an increasing trend.Conclusions1. Premature children is a high incidence of nosocomial infection groups, ourhospital NICU preterm children hospital infection rate of12.9%, a higher rate ofinfection within the very low birth weight children hospital, multi-resistantinfections account for a higher proportion of the urgent need to strengthen theprevention and control of hospital infection measures and rational use of antibiotics.2. Gram-negative bacilli is my hospital NICU nosocomial infection pathogens, themost common, in which the multi-drug-resistant pneumonia Klebsiella, PiperacillinTazobactam,risperidone sulbactam, and carbon carbapenem is preferred, but maylead to increase the proportion of resistant bacteria.3. Lung infection most common in preterm children hospital infection, followed bysepsis. gestational age <32weeks, mechanical ventilation, parenteral nutrition, earlyuse of antibiotics and third generation cephalosporin antibiotic use is a significantrisk factors of nosocomial infection.4. It is not clear weither antibiotics, especially in advance the use of antibiotics andpreterm children hospital infection-resistant pathogens relationship, and but highearly use of antibiotics may lead to the generation of multi-resistant bacteria.