Analysis Of The Nosocomial Infection And Risk Factors In Neonatal Intensive Care Unit

Objective 1)To clarify the incidence of nosocomial infection of neonatal intensive care unit(NICU)in one children's hospital of shanghai.2)To obtain the location and pathogen distribution of nosocomial infection.3)To explore the risk factors of neonatal nosocomial infection and prognosis.Methods 1)A prospective survey was conducted.There were 6927 neonates hospitalized in NICU born within 28 days from April 2014 to October 2016.A total of 5797 neonates were enrolled removed those stay in NICU less than 48 hours.Full-time staff of nosocomial infection collected case information by reviewing electronic medical records,monitoring information systems of nosocomial infection and bedside survey.2)The odds ratio(OR)and 95%confidence interval(CI)were estimated between the monitoring variables and the nosocomial infection using multivariate unconditional logistic regression.All analyzes were carried out by SAS 9.13.Adopted two sided test,confidence level a = 0.05.Results The total number of hospital days were 68043 for 5797 neonates.Two hundred and fifty-five neonates(272 cases)suffered from nosocomial infection.Seventeen neonates happened twice nosocomial infection.The incidence of nosocomial infection was 4.40%and the rate of cases was 4.69%(3.75 cases/1000 hospital days,4.00/1000 hospital days).There were 103 neonates suffered from pulmonary infection(1.78%,1.51 cases/1000 hospital days).Thirty-four neonates infected VAP(0.59%,2.87 cases/1000 MV-days).A total of 73 cases suffered from bloodstream infection(1.26%,1.07 cases/1000 hospital days).Thirty-five neonates happened CRBSI(2.48%,1.98 cases/1000 CVC-days).One hundred and there pulmonary infection were the the major infection location,non-catheter-related pulmonary infection was 69 cases(25.37%)and VAP was 34 cases(12.50%)among them.Eighty cases happened non-catheter-related urinary tract infection(29.41%).There were 39 cases(14.34%)non-catheter-related bloodstream infection and 35 cases CRBSI(12.87%).A total of 275 strains were detected,176 strains of Gram-negative bacteria(64.00%),58 strains of Gram-positive bacteria(21.09%),41 strains of fungi(14.91%).Klebsiella pneumoniae(110 strains),Escherichia coli(21 strains)and Acinetobacter baumannii(18 strains)were the major bacteria of Gram-negative bacteria.The main Gram-positive bacteria included Enterococcus(33 strains),other gram-positive cocci(12 strains),MSCNS(5 strains).The independent risk factors of nosocomial infection included gestational age<37 weeks(OR=1.71,95%CI:1.11-2.62),birth weight<1501 g(OR=1.65,95%CI:1.18-2.30),5 minutes Apgar score<7(OR=4.63,95%CI:3.34-6.41),twins or triplets(OR=18.77,95%CI:11.77-29.91),length of stay in hospital>=10(OR=22.66,95%CI:12.11-42.42),CVC-days>=4(ORF=1.66,95%CI:1.23-2.24)and MV-days>=8(OR=1.79,95%CI:1.31-2.44).Twins or triplets(OR=14.79,95%CI:6.09-36.81),length of stay in hospital>=10(OR=14.06,95%CI:1.90-104.20),MV-days>=8(OR=25.60,95%CI:5.62-55.64)were the risk factors associated with VAP in NICU.Five risk factors were found to be related to neonatal CRBSI which were listed as follows in order by odds ratios(OR,95%CI):gestational age<37 weeks(OR=6.10,95%CI:1.41-26.34),5 minutes Apgar score<7(OR=5.20,95%CI:2.43-11.14),twins or triplets(OR=6.13,95%CI:2.47-15.24),CVC-days>=4(OR=86.58,95%CI:11.66-642.70),MV-days>=8(OR=2.91,95%CI:1.40-6.05).The mortality rate of nosocomial infection group was 2.75%(7/255)versus 1.14%(63/5542)in non-nosocomial infection group(?2 =5.2861,P=0.0215).Multivariable logistic regression modeling defined 5 minutes Apgar score...