Cipolla Domenico, Giuffrè Mario, Mammina Caterina, Corsello Giovanni
Department of Neonatology and Neonatal Intensive Care, University of Palermo, Italy.
J Matern Fetal Neonatal Med. 2011 Oct;24 Suppl 1:23-6. doi: 10.3109/14767058.2011.607567.
Neonates hospitalized in NICU are at risk for healthcare associated infections because of their poor immune defenses, related to gestational age, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers (HCWs). Healthcare associated infections are the major source of morbidity and mortality in NICU in the developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. Hand hygiene is the most important preventive procedure, nevertheless hand hygiene compliance among HCWs remains low. Continuous educational strategies can improve hand hygiene and contribute to reducing the incidence of neonatal infections. Other important prevention strategies include early enteral feeding with human milk, minimization and safety in the use of invasive devices, limiting unnecessary empiric broadspectrum antibiotics, eventual use of lactoferrin bifidobacteria and lactobacilli, prophylactic administration of fluconazole in VLBW. Emergence of multi drug resistant organisms (MDRO) is a worrying perspective. Methicillin-resistant Staphylococcus aureus (MRSA) is an important healthcare-associated pathogen. Active surveillance culturing for MRSA carriers, in combination with contact precautions and decolonization in some hyperendemic settings, has been proved to reduce MRSA transmission and infection rates. Multidrug-resistant Gram-negatives are frequently reported. Overuse of antimicrobial drugs and crosstransmission via caregiver hands, contaminated equipment or inanimate objects are the major drivers of selection and dissemination. Strategies to control outbreaks of MDRO colonization/infection in the NICU may include performing hand hygiene, cohorting and isolating patients, screening healthcare workers and performing admission and periodic surveillance cultures.
入住新生儿重症监护病房（NICU）的新生儿由于免疫防御能力差而面临医疗相关感染的风险，这与胎龄、黏膜和皮肤被医院微生物定植、接触抗生素、侵入性操作以及频繁接触医护人员有关。在发达国家，医疗相关感染是NICU发病和死亡的主要原因。大多数感染由革兰氏阳性菌引起，暴发性败血症通常与革兰氏阴性菌有关，真菌性败血症在极低出生体重儿中经常发生。手部卫生是最重要的预防措施，然而医护人员的手部卫生依从性仍然很低。持续的教育策略可以改善手部卫生并有助于降低新生儿感染的发生率。其他重要的预防策略包括早期母乳喂养、尽量减少侵入性设备的使用并确保其安全性、限制不必要的经验性广谱抗生素使用、酌情使用乳铁蛋白、双歧杆菌和乳酸杆菌、对极低出生体重儿预防性使用氟康唑。多重耐药菌（MDRO）的出现是一个令人担忧的问题。耐甲氧西林金黄色葡萄球菌（MRSA）是一种重要的医疗相关病原体。已证明，在某些高流行环境中，对MRSA携带者进行主动监测培养，结合接触预防措施和去定植，可降低MRSA的传播和感染率。多重耐药革兰氏阴性菌也经常被报道。抗菌药物的过度使用以及通过护理人员的手、受污染的设备或无生命物体的交叉传播是选择和传播的主要驱动因素。控制NICU中MDRO定植/感染暴发的策略可能包括手部卫生、对患者进行分组和隔离、对医护人员进行筛查以及进行入院和定期监测培养。
