Perlman Sharon E, Saiman Lisa, Larson Elaine L
Mailman School of Public Health, Columbia University, New York, NY, USA.
Am J Infect Control. 2007 Apr;35(3):177-82. doi: 10.1016/j.ajic.2006.01.002.
There are few data comparing risk factors for catheter-related (CR) versus non-CR bloodstream infection (BSI) or for BSI caused by gram-positive versus gram-negative organisms. The aims of this study were to compare risk factors for CR versus non-CR BSI and to compare risk factors for BSI associated with gram-negative versus gram-positive organisms among infants hospitalized in two neonatal intensive care units (NICUs).
Data were collected prospectively over a 2-year period to assess risk factors among 2,935 neonates from two NICUs.
Among all neonates, in addition to low birth weight and presence of a central venous catheter, hospitalization in NICU 1 (relative risk [RR]: 1.60, 95% confidence intervals [CI]: 1.14, 2.24) was a significant predictor of BSI. In neonates with a central catheter total parenteral nutrition (TPN) was a significant risk factor for BSI (RR: 4.69, 95% CI: 2.22, 9.87). Ventilator use was a significant risk factor for CR versus non-CR BSI (RR: 3.74, 95% CI: 1.87, 7.48), and significantly more CR BSI were caused by gram-positive (77.1%) than by gram-negative organisms (61.4%), P = .03.
This study confirmed that central venous catheters and low birth weight were risk factors for neonates with late-onset healthcare-associated BSI and further elucidated the potential risks associated with TPN and ventilator use in subgroups of neonates with BSI. Additional studies are needed to examine the incremental risk of TPN among infants with central venous catheters and to understand the link between CR BSI and ventilator use. Preventive strategies for BSI in neonates in NICUs should continue to focus on limiting the use of invasive devices.
关于导管相关（CR）与非CR血流感染（BSI）的危险因素比较，以及革兰氏阳性菌与革兰氏阴性菌所致BSI的危险因素比较的数据较少。本研究的目的是比较CR与非CR BSI的危险因素，并比较在两个新生儿重症监护病房（NICU）住院的婴儿中，革兰氏阴性菌与革兰氏阳性菌所致BSI的危险因素。
前瞻性收集了两年期间的数据，以评估来自两个NICU的2935例新生儿的危险因素。
在所有新生儿中，除低出生体重和存在中心静脉导管外，在NICU 1住院（相对危险度[RR]：1.60，95%置信区间[CI]：1.14，2.24）是BSI的一个显著预测因素。在有中心导管的新生儿中，全胃肠外营养（TPN）是BSI的一个显著危险因素（RR：4.69，95%CI：2.22，9.87）。使用呼吸机是CR与非CR BSI的一个显著危险因素（RR：3.74，95%CI：1.87，7.48），并且由革兰氏阳性菌引起的CR BSI（77.1%）显著多于革兰氏阴性菌（61.4%），P = 0.03。
本研究证实中心静脉导管和低出生体重是迟发性医疗相关BSI新生儿的危险因素，并进一步阐明了在BSI新生儿亚组中与TPN和使用呼吸机相关的潜在风险。需要进一步研究以检查中心静脉导管婴儿中TPN的增量风险，并了解CR BSI与使用呼吸机之间的联系。NICU中新生儿BSI的预防策略应继续侧重于限制侵入性装置的使用。
