塞浦路斯早产儿晚发型新生儿败血症的流行病学、危险因素、临床表现和并发症：一项前瞻性病例对照研究。
Epidemiology, risk factors, clinical presentation and complications of late-onset neonatal sepsis among preterm neonates in Cyprus: a prospective case-control study.
机构信息
Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus.
Respiratory Physiology Laboratory, Medical School, University of Cyprus Shakolas Educational Center of Clinical, Medicine Palaios Dromos Lefkosias Lemesou 215/6, Aglantzia, Nicosia, 2029, Cyprus.
出版信息
BMC Pediatr. 2024 Jan 16;24(1):50. doi: 10.1186/s12887-023-04359-6.
BACKGROUND
Late-onset neonatal sepsis (LOS) is common in preterm neonates, with increasing incidence in recent years. In the present study, we examined the epidemiology, clinical presentation, and complications of LOS in Cyprus and quantified possible risk factors for the development of this condition.
METHODS
The study subjects were preterm neonates admitted in the Neonatal Intensive Care Unit (NICU) of Archbishop Makarios III Hospital, the only neonatal tertiary centre in Cyprus. A prospective, case-control study was designed, and carried out between April 2017-October 2018. Depending on blood culture results, preterm neonates were classified as "Confirmed LOS": positive blood culture - microorganism isolated and LOS symptoms, "Unconfirmed LOS": negative blood culture and LOS symptoms, and "Controls" group: negative blood culture and absence of LOS symptoms. Comparisons between the 3 groups were performed and the associations between demographic, clinical and treatment characteristics with the likelihood of LOS were assessed using univariate and multivariate logistic regression.
RESULTS
A total of 350 preterm neonates were included in the study and the incidence of LOS was 41.1%. 79 (22.6%) and 65 (18.6%) neonates were classified as "Confirmed LOS", and "unconfirmed LOS" cases respectively while 206 (58.9%) served as controls. The rate of confirmed LOS ranged from 12.2% in moderate to late preterm neonates to 78.6% in extremely preterm neonates. In the multivariate model, we demonstrated an independent association between LOS and duration of hospitalization (OR: 1.06, 95%CI: 1.01-1.10), duration of ventilation (OR: 1.23, 95%CI: 1.07-1.43) and necrotising enterocolitis (OR: 3.41, 95%CI: 1.13-10.25).
CONCLUSIONS
The present study highlights the epidemiology of LOS in preterm neonates in Cyprus and its association with the duration of ventilation and hospitalization as well as with necrotizing enterocolitis. Establishment of protocols for the prevention of nosocomial infections during hospitalization in the NICUs and mechanical ventilation of preterm neonates is recommended.
背景
晚发型新生儿败血症（LOS）在早产儿中很常见，近年来发病率呈上升趋势。本研究旨在探讨塞浦路斯早产儿 LOS 的流行病学、临床表现和并发症，并量化了发生这种情况的可能危险因素。
方法
研究对象为入住塞浦路斯大主教 Makarios III 医院新生儿重症监护病房（NICU）的早产儿。采用前瞻性病例对照研究设计，于 2017 年 4 月至 2018 年 10 月进行。根据血培养结果，将早产儿分为“确诊 LOS”：血培养阳性-分离出微生物和 LOS 症状、“未确诊 LOS”：血培养阴性和 LOS 症状、“对照组”：血培养阴性且无 LOS 症状。对 3 组进行比较，并采用单因素和多因素逻辑回归评估人口统计学、临床和治疗特征与 LOS 发生的相关性。
结果
共纳入 350 例早产儿，LOS 发生率为 41.1%。79 例（22.6%）和 65 例（18.6%）早产儿分别被归类为“确诊 LOS”和“未确诊 LOS”病例，206 例（58.9%）作为对照组。确诊 LOS 发生率在中晚期早产儿中为 12.2%，在极早产儿中为 78.6%。在多因素模型中，我们证明 LOS 与住院时间（OR：1.06，95%CI：1.01-1.10）、通气时间（OR：1.23，95%CI：1.07-1.43）和坏死性小肠结肠炎（OR：3.41，95%CI：1.13-10.25）独立相关。
结论
本研究强调了塞浦路斯早产儿 LOS 的流行病学及其与通气时间和住院时间以及坏死性小肠结肠炎的关系。建议制定 NICU 住院期间预防医院感染和早产儿机械通气的方案。
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