Kilic Atila, Okulu Emel, Kocabas Bilge Aldemir, Alan Serdar, Cakir Ufuk, Yildiz Duran, Kahvecioglu Dilek, Akin Ilke Mungan, Erdeve Omer, Arsan Saadet, Ince Erdal, Atasay Begum
Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
J Infect Dev Ctries. 2019 Mar 31;13(3):181-187. doi: 10.3855/jidc.10688.
Health care-associated infection (HCAI) is a serious problem of neonatal intensive care units (NICUs) which is related to morbidity, mortality and increased cost of medical care. This study aimed to determine the incidence of HCAI in a tertiary NICU and identify the risk factors.
This prospective cohort study was conducted between July 1, 2011 and June 30, 2012. All newborns admitted to the NICU except for those who died or were discharged within 48 hours after admission were included. The definitions of Centers for Disease Control and Prevention (CDC) were used to diagnose specific types of infections. The incidence, causative organisms, risk factors and mortality of HCAIs were evaluated.
Among 352 newborns, a total of 60 HCAI episodes were evaluated in 37 (10.5%) of the patients over 5,212 patient-days. The overall incidence of HCAI was 17%, and the rate was 11.5/1,000 patient-days. Blood stream infection (BSI) was the most common HCAI (n = 42, 70%). In a multivariable logistic regression analysis, the presence of a central venous catheter/umbilical catheter (CVC/UC), the presence of a urinary catheter, and gestational age (< 32 weeks of gestation) were identified as significant independent risk factors. Gram-negative pathogens were the most common isolates. The overall mortality rate was 4%. The HCAI-related mortality rate was 10.8%.
Patient care quality can be improved with surveillance of HCAI. The incidence and rate of HCAI in our NICU were found to be higher than international reports with a direct impact on mortality of preterm infants.
医疗保健相关感染（HCAI）是新生儿重症监护病房（NICU）面临的一个严重问题，它与发病率、死亡率以及医疗费用增加相关。本研究旨在确定一家三级NICU中HCAI的发生率，并识别风险因素。
本前瞻性队列研究于2011年7月1日至2012年6月30日进行。纳入所有入住NICU的新生儿，但入院后48小时内死亡或出院的新生儿除外。采用疾病控制与预防中心（CDC）的定义来诊断特定类型的感染。对HCAIs的发生率、致病微生物、风险因素和死亡率进行评估。
在352例新生儿中，在5212个患者日期间，对37例（10.5%）患者的总共60次HCAI发作进行了评估。HCAI的总体发生率为17%，发生率为11.5/1000患者日。血流感染（BSI）是最常见的HCAI（n = 42，70%）。在多变量逻辑回归分析中，中心静脉导管/脐导管（CVC/UC）的存在、导尿管的存在以及胎龄（<32周妊娠）被确定为显著的独立风险因素。革兰氏阴性病原体是最常见的分离株。总体死亡率为4%。HCAI相关死亡率为10.8%。
通过对HCAI的监测可以提高患者护理质量。我们NICU中HCAI的发生率和发生率高于国际报告，对早产儿死亡率有直接影响。
