Khadilkar V, Tudehope D, Fraser S
Department of Neonatology, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.
J Paediatr Child Health. 1995 Oct;31(5):387-91. doi: 10.1111/j.1440-1754.1995.tb00843.x.
To determine the incidence of and organisms responsible for neonatal nosocomial infection (after 72 h of age).
A 1-year evaluation of 321 consecutive septic work-ups performed on 130 of 1008 babies admitted to a neonatal intensive care unit (NICU) for more than 72 h. Fifty-seven (89%) of 64 infants of birthweight 500-999 g, 36 (34%) of 105 infants 100-1499 g, 27 (6%) of 422 infants 1500-2499 g and 10 (28%) of 477 infants of birthweight > 2500 g had at least one septic work-up.
In addition to blood culture, the evaluations included haematological score on full blood count in 94.7%, abdominal X-ray in 48%, endotracheal tube tip culture in 32.7% and lumbar puncture in only 13.1%. Blood culture was positive on 92 occasions in 75 infants (28.7% of work-ups and 7.4% of all babies admitted). Infection status was classified as definite on 40 occasions in 30 babies, and due to contamination 52 in 45 babies. Twenty of the 30 babies with definite infection were of birthweight 500-999 g. Of the 40 definite infections coagulase-negative staphylococci (CONS) were cultured from 23 babies, Gram negative bacilli in 14 and Candida spp. in three babies. Sepsis caused or contributed to the deaths of six babies.
This study identifies infants of birthweight < 1000 g as the highest risk group for nosocomial infection especially CONS. New strategies in prevention, surveillance and treatment are required for extremely low birthweight infants.
确定新生儿医院感染（出生72小时后）的发生率及病原菌。
对入住新生儿重症监护病房（NICU）超过72小时的1008例婴儿中的130例进行了连续321次败血症检查的为期1年的评估。出生体重500 - 999克的64例婴儿中有57例（89%）、100 - 1499克的105例婴儿中有36例（34%）、1500 - 2499克的422例婴儿中有27例（6%）以及出生体重>2500克的477例婴儿中有10例（28%）至少接受了一次败血症检查。
除血培养外，检查还包括94.7%的全血细胞计数血液学评分、48%的腹部X线检查、32.7%的气管导管尖端培养以及仅13.1%的腰椎穿刺。75例婴儿的血培养有92次呈阳性（占检查的28.7%，占所有入院婴儿的7.4%）。30例婴儿的感染状态在40次检查中被判定为确诊，45例婴儿中有52次检查结果归因于污染。30例确诊感染的婴儿中有20例出生体重为500 - 999克。在40例确诊感染中，23例婴儿培养出凝固酶阴性葡萄球菌（CONS），14例培养出革兰氏阴性杆菌，3例婴儿培养出念珠菌属。败血症导致6例婴儿死亡或促使其死亡。
本研究确定出生体重<1000克的婴儿是医院感染尤其是CONS感染的最高风险群体。极低出生体重儿需要新的预防、监测和治疗策略。
