| Objective: To investigate epidemiological and clinical characteristicsand risk factors for nosocomial infection (NI) in very low birth weightinfants (VLBWIs) in neonatal intensive care unit(NICU) to provideevidence for prevention and control of NI.Methods：220VLBWIs who were admitted to NICU of Children’sHospital affiliated to Chongqing Medical University and stayed for over48hours between January2010and December2011were selected in thisstudy. Their clinical data, such as demographic information, clinicalmanifestations, etiological tests, invasive operations, were collected andanalyzed retrospectively with SPSS (version19.0).220VIBWIs weredivided into NI group and non-NI group to assess risk factors for NI inVLBWIs, assisting in building up NI control strategies.Results：1. There were220VLBWIs in the study, with88cases in NI groupand132cases in non-NI group.88cases in NI group suffered from125NIs;that was1.4（125/88) NIs for each one in average. The incidence of NI was40.0%（88/220*100%) and hospital stay-related incidence was19.5‰ （125/6420*1000‰).2. Positive rates of nonspecific indexes, abnormal white blood cellcount, abnormal temperature, increase of C-reactive protein, decrease ofplatelet and increase of I/T included, were47.7%,44.3%,40.9%,36.4%,19.3%in NI group, all of which were higher than those in non-NI group.And these differences between groups are statistically significant（P＜0.05).3.69.3%of NI occurs within3weeks after admission. Among125NIs, there were83(66.4%) respiratory tract infections,19(15.2%)digestive tract infections,15(12.0%) septicemia and8(6.4%) infections inother sites.4. There were108strains of pathogen isolated from131specimens.97strains were G-bacteria and11strains were fungus. Among48strains of G-bacteria, positive rate of ESBL test was100.0%. Resistance rate ofPenicillins and Cephalosporins among97strains of G-bacteria was up to88.3%～97.9%, while it was less than30%of Quinolones andCarbapenems.5. Antibiotic use intensity was3.65in220VLBWIs,3.76in NI groupand2.32in non-NI group. Antibiotic consumption was (1.67±1.21)g/DDDfor each VLBWI in NI group, wherea（s0.62±0.50)g/DDD in non-NI group,and there is significant difference between groups（t=8.927，P=0.000).6. Average length of hospital stay was（44.38±25.98)days in NI group, （19.05±15.29)days in non-NI group, and the difference is statisticallysignifican（tt=8.242，P=0.000). Withdrawal/death rate was38.6%(34/88) inNI group,37.1%(49/132) in non-NI group, while there is no significantdifference（χ2=0.052，P=0.820).7. Logistic regression shows that independent risk factors for NIinclude hospital stay for over28days, mechanical ventilation for over72hours and intravenous lipid emulsion for over14days. Area under receiveroperating characteristic (ROC) is0.830(SE=0.029, P=0.000，95%CI[0.774～0.887]), which proves this model accords with reality.Conclusions：1. NI in VLBWIs, the morjority of which was respiratory tractinfection, was high in incidence. It prolonged duration of hospital stay andgreatly increased antibiotic use intensity and antibiotic consumption.2. Most of NI pathogens were G-bacteria, whose resistance rate ofPenicillins and Cephalosporins was very high, while it was much lower forQuinolones and Carbapenems.3. For better control of NI in VLBWIs, it is vital to implementeffective approaches to shorten duration of hospital stay, mechanicalventilation and intravenous lipid emulsion. |
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