预防性应用抗生素与早产儿院内感染的关系及其危险因素分析

发布时间：2018-05-10 17:10

  本文选题：抗生素 + 院内感染　； 参考：《吉林大学》2012年硕士论文

【摘要】：近年来，随着新生儿救治水平的逐渐提高，早产儿的存活率明显升高，而早产儿院内感染则越来越受到人们的重视，感染性疾病已成为导致新生儿重症监护病房（neonatal intense care unit，NICU）中患儿死亡的最常见原因之一。早产儿是一个特殊群体，因其器官发育不成熟、机体免疫功能低下，接受各种侵袭性操作机会多、住院时间长等特点，使其院内感染发病率高，对于早产儿是否应预防性应用抗生素越来越受到国内外专家的关注。有学者认为早产儿生后预防性应用抗生素可以降低院内感染的发生率，也有专家持不同意见。本文主要研究预防性应用抗生素与早产儿院内感染发病的关系，以及针对12项早产儿院内感染的可疑危险因素进行分析，进一步明确预防性应用抗生素是否对早产儿院内感染有保护性作用，并明确早产儿院内感染发病的危险因素，旨在对早产儿临床合理应用抗生素能起到一定的指导作用。本文采用回顾性收集病例资料，在2009年1月-2011年12月吉林大学第一医院新生儿科收治的符合研究条件的早产儿中抽取409例，按照是否发生院内感染将样本分为2组，即感染组与非感染组，将生后48小时内预防性应用抗生素设为可疑保护因素，胎龄（gestational age，GA）、出生体重（birth weight，BW）、开奶时间、机械通气（mechanical ventilation，MV）、外周置入中心静脉导管（peripherallyInserted Central Catheter，PICC）、动脉置管、住院时间等视为可疑危险因素，应用χ2检验及多因素非条件逐步Logistic回归分析明确早产儿院内感染的危险因素以及预防性应用抗生素对早产儿院内感染是否有保护作用。结果显示：1．将2组中上述影响因素行单因素χ2检验，结果显示：GA≤32w，BW≤1500g，开奶时间在生后5d以后，应用MV，PICC，，动脉置管，住院时间大于2w以及预防性应用抗生素均与院内感染显著相关（P值均＜0.01）；2．进一步logistic多因素回归分析，显示GA≤32w（P=0.031，OR=1.738）、BW≤1500g（P=0.032，OR=1.849）及住院时间大于2w（P=0.000，OR=6.446）为早产儿院内感染的独立危险因素，其中院内感染的发生率随GA及BW的增加而降低，预防性应用抗生素并非院内感染的保护因素（P=0.91，OR=1.029）；3．409例病例中，有191例发生院内感染，院内感染发生率为46.7%，其中以肺炎局首位；4．共培养出病原菌27株，细菌以肺炎克雷伯杆菌为主，真菌以白假丝酵母菌为主。结论：1．预防性应用抗生素为并非院内感染的保护因素；2．GA≤32w、BW≤1500g、开奶时间在生后5d以后、应用MV、PICC、动脉置管、住院时间大于2w以及预防性应用抗生素均为早产儿院内感染的危险因素；3．GA≤32w、BW≤1500g及住院时间大于2w为早产儿院内感染的独立危险因素，院内感染的发生率随GA及BW的升高而降低；4．预防早产儿院内感染的有效措施为加强早产儿综合管理以及正确合理使用抗生素。
[Abstract]:In recent years, with the gradual improvement of the level of neonatal treatment, the survival rate of premature infants has increased significantly, while nosocomial infection of premature infants has been paid more and more attention. Infectious diseases have become one of the most common causes of death in neonatal intense care unit. Premature infants are a special group, because their organs are immature, their immune function is low, they have many opportunities to accept various invasive operations, and their hospital stay is long, so the incidence of nosocomial infection is high. More and more experts at home and abroad pay more and more attention to the prophylactic use of antibiotics for preterm infants. Some scholars believe that prophylactic use of antibiotics can reduce the incidence of nosocomial infection in preterm infants. The relationship between prophylactic use of antibiotics and nosocomial infection in premature infants was studied, and the suspicious risk factors of nosocomial infection in 12 premature infants were analyzed. To further determine whether prophylactic use of antibiotics has protective effect on nosocomial infection of premature infants and the risk factors of nosocomial infection of premature infants, the purpose of this study is to provide guidance for rational use of antibiotics in clinical practice of premature infants. From January 2009 to December 2011, 409 premature infants who were admitted to the Department of Neonatrics in the first Hospital of Jilin University were selected and divided into two groups according to whether or not nosocomial infection occurred. In the infection group and the non-infection group, prophylactic use of antibiotics within 48 hours after birth was regarded as a suspicious protective factor. Gestational age, birth weight, milk opening time, mechanical ventilation, peripheral placement of central venous catheter, peripheral catheter inserted into the central vein, catheterization, arterial catheterization. Hospital stay was regarded as a suspicious risk factor. 蠂 2 test and multivariate stepwise Logistic regression analysis were used to determine the risk factors of nosocomial infection of premature infants and whether prophylactic use of antibiotics had protective effect on nosocomial infection of preterm infants. The result is 1: 1. Univariate 蠂 2 test was performed on the above factors in the two groups. The results showed that the weight GA 鈮

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