影响患有腹壁缺陷新生儿的医院感染

Nosocomial Infections Affecting Newborns with Abdominal Wall Defects.

作者信息

Ţarcă Elena, Cojocaru Elena, Trandafir Laura Mihaela, Melinte Popescu Marian George, Luca Alina Costina, Butnariu Lăcrămioara Ionela, Hanganu Elena, Moscalu Mihaela, Ţarcă Viorel, Stătescu Laura, Radu Iulian, Melinte Popescu Alina Sinziana

机构信息

Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iaşi, Romania.

Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iaşi, Romania.

出版信息

Healthcare (Basel). 2023 Apr 14;11(8):1131. doi: 10.3390/healthcare11081131.

DOI:10.3390/healthcare11081131

PMID:37107965

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10137964/

Abstract

UNLABELLED

Abdominal wall defects are serious birth defects, with long periods of hospitalization and significant costs to the medical system. Nosocomial infection (NI) may be an additional risk factor that aggravates the evolution of newborns with such malformations.

METHODS

in order to analyze the factors that may lead to the occurrence of NI, we performed a retrospective study over a period of thirty-two years (1990-2021), in a tertiary children's hospital; 302 neonates with omphalocele and gastroschisis were eligible for the study.

RESULTS

a total of 33.7 % patients were infected with one or more of species of bacteria or fungi. These species were , and spp., spp., spp. or spp., but the rate of NI showed a significant decrease between the 1990-2010 and 2011-2021 period ( = 0.04). The increase in the number of surgeries was associated with the increase in the number of NI both for omphalocele and gastroschisis; in the case of gastroschisis, the age of over 6 h at the time of surgery increased the risk of infection ( = 0.052, marginal statistical significance). Additionally, for gastroschisis, the risk of NI was 4.56 times higher in the presence of anemia ( < 0.01) and 2.17 times higher for the patients developing acute renal failure ( = 0.02), and a hospitalization period longer than 14 days was found to increase the risk of NI 3.46-fold ( < 0.01); more than 4 days of TPN was found to increase the NI risk 2.37-fold ( = 0.015). Using a logistic regression model for patients with omphalocele, we found an increased risk of NI for those in blood group 0 (OR = 3.8, = 0.02), in patients with a length of hospitalization (LH) of ≥14 days (OR = 6.7, < 0.01) and in the presence of anemia (OR = 2.5, = 0.04); all three independent variables in our model contributed 38.7% to the risk of NI.

CONCLUSION

although in the past 32 years we have seen transformational improvements in the outcome of abdominal wall defects, there are still many factors that require special attention for corrections.

摘要

未标注

腹壁缺陷是严重的出生缺陷，会导致新生儿长期住院，给医疗系统带来巨大成本。医院感染（NI）可能是加重患有此类畸形新生儿病情发展的一个额外风险因素。

方法

为了分析可能导致医院感染发生的因素，我们在一家三级儿童医院进行了一项为期32年（1990 - 2021年）的回顾性研究；302例患有脐膨出和腹裂的新生儿符合研究条件。

结果

共有33.7%的患者感染了一种或多种细菌或真菌。这些菌种包括、和菌属、菌属、菌属或菌属，但在1990 - 2010年和2011 - 2021年期间，医院感染率显著下降（ = 0.04）。手术数量的增加与脐膨出和腹裂的医院感染数量增加相关；对于腹裂，手术时年龄超过6小时会增加感染风险（ = 0.052，具有边缘统计学意义）。此外，对于腹裂，贫血时医院感染风险高4.56倍（ < 0.01），发生急性肾衰竭的患者感染风险高2.17倍（ = 0.02），住院时间超过14天会使医院感染风险增加3.46倍（ < 0.01）；接受全胃肠外营养超过4天会使医院感染风险增加2.37倍（ = 0.015）。对脐膨出患者使用逻辑回归模型，我们发现血型为O型的患者医院感染风险增加（比值比 = 3.8， = 0.02），住院时间（LH）≥14天的患者（比值比 = 6.7， < 0.01）以及存在贫血的患者（比值比 = 2.5， = 0.04）；我们模型中的所有三个自变量对医院感染风险的贡献率为38.7%。