住院早产儿医院感染临床分析住院早产儿医院感染临床分析【摘要】目的探讨早产儿医院感染发生率(院感率)的相关高危因素，揭示其病原学特点，指导临床工作。方法对869例早产儿的临床相关资料进行调查、登记和分析，总结早产儿医院感染(院感)与岀生体重、住院天数的关系，分析其病原体和耐药情况。结果869例早产儿院感率为3.6%,其中101例极低出生体重(VLBW)儿院感率10.9%,768例低出生体重(LBW)儿院感率2.6%❷；足月儿院感率仅0.7%；早产儿院感多发生在住院的第2〜3周，VLBW儿院感多发生在第3周，LBW儿院感多发生在第2周；早产儿院感以下呼吸道感染最多见，其次为皮肤黏膜感染;病原体大多数是革兰氏阴性(G-)杆菌，其中肺炎克雷伯杆菌肺炎亚种高达57.1%,产ESBL酶杆菌和MRSA葡萄球菌达80.0%o结论早产儿尤其VLBW儿易发生院感，住院后2~3周内出现呼吸道感染多见，病原菌以耐药G-杆菌(肺炎克雷伯杆菌肺炎亚种)为主，临床上应高度注意，防止其在新生儿病室暴发传播。【关键词】医院感染；早产儿；病原学；耐药性AClinicalAnalysisofHospitalizedPrematureNeonates，NosocomialInfectionFANYan-zhou,XIAOZhengxiang.(DepartmentofPediatrics,ZhuzhouPeople'sHospitalDepartmentofPediatrics,ZhuzhouAffiliatedHospital,ChangshaMedicalCollege,Zhuzhou,412000,China)[Abstract]ObjectivesToprobethefactorsthatcausetheinfectionofthehospitalizedprematureneonatesandrevealthefeaturesofitsetiologicalfeaturesandthereforeprovideaguidelinefortheclinicalpractice・MethodsByinvestigating,andscreeningthedocumentsof869hospitalizedprematureneonates,thepapertriestoestablishandidentifytherelationshipbetweentherateoftheirinfectionandtheirweightatbirthandthedaysinhospital,andmakeasystematicanalysisoftheirspecificpathogensanddrugtolerance・ResultsTheresearchrevealsthat3.6%ofthe869prematureneonatesdevelopedhospitalinfection.10.9%of101prematureneonateswithverylowbirthweight(VLBW)developedinfection,and2.6%of768prematureneonateswithlowbirthweight(LBW)developedinfection,whiletherateofhospitalizedmatureneonatesisonly0.7%.Mostcasesofhospitalinfectionoccurredinthesecondorthirdweek・PrematureneonateswithVLBWwereofteninfectedintheirthirdweek・,andprematureneonateswithLBWintheirsecondweek・Thehospitalinfectionofprematureneonateswascharacterizedbytheinfectionoflowrespiratorytractandsecondskinormembrane・MostoftheinfectiouspathogensarethesubspeciesofGram-negativebacillus,ofwhichthesubspeciesofKlebsiellapneumoniaeaccountedfor57.1%,andESBLbacillusandMRSAstaphylococci80.0%.ConclusionPrematureneonates,especiallythosewithVLBW,arepredisposedtonosocomialinfection,whichoftenoccursintheirsecondorthirdweekinhospita1.Theinfectiouspathogensarepredominatedbythedrug-resistantGram-negativebacillus,especiallysubspeciesofKlebsiellapneumoniae・Precautionsshouldbemadetopreventitsexplosivespreadinthewardofneonates・[Keywords]Nosocomialinfection;Prematureneonate;etiology;drugresistan【中图分类号】R722【文献标识码】A【文章编号】1814-8824(2009)-05-0013-031资料与方法1.1一般资料株洲市人民医院儿科和深圳市龙岗区妇幼保健院新生儿科于2005年4月〜2009年3月共收治新生儿4475例次，男2369例次,女2106例次；足月儿3606例次，早产儿869例次。1.2临床资料院感早产儿出生体重为1.0-2.6kg,中位数为1.67；胎龄为28+4❷〜36+5❷周，中位数为32+6❷；住院吋H龄为生后0・5h〜3d,住院时间为6d〜56d,中位数为21d。原发病中，呼吸窘迫综合征38例、宫内感染13例、胎膜早破25例，入院时使用一种抗生素；呼吸机支持的早产儿70例；VLBW早产儿住院第1周内均予人血丙种球蛋白(1.0g/kgX3d)和部分肠外营养液静滴；所有早产儿均放置温箱内至体温稳定或/和体重达2.0kg❷。1.3诊断标准中国卫生部2001年颁发的《医院感染...