Fowlie P W, Gould C R, Parry G J, Phillips G, Tarnow-Mordi W O
Department of Child Health, Ninewells Hospital and Medical School, University of Dundee.
Arch Dis Child Fetal Neonatal Ed. 1996 Jul;75(1):F49-52. doi: 10.1136/fn.75.1.f49.
Positive blood cultures in very low birthweight or preterm infants usually reflect bacteraemia, septicaemia, or failure of asepsis during sampling and lead to increased costs and length of stay. Rates of nosocomial, or hospital acquired, bacteraemia may therefore be important indicators of neonatal unit performance, if comparisons are adjusted for differences in initial risk. In a preliminary study the risk of nosocomial bacteraemia was related to initial clinical risk and illness severity measured by the clinical risk index for babies (CRIB). Nosocomial bacteraemia was defined as clinically suspected infection with culture of bacteria in blood more than 48 hours after birth. One or more episodes of nosocomial bacteraemia were identified retrospectively in 36 of 143 (25%) infants in a regional neonatal unit between 1992 and 1994. Biologically plausible models were developed using regression analysis techniques. After correcting for period at risk, nosocomial bacteraemia was independently associated with gestation at birth and CRIB. Death was independently associated with CRIB, but not with nosocomial bacteraemia. CRIB may contribute, with other explanatory variables, to more comprehensive predictive models of death and nosocomial infection. These may facilitate future risk adjusted comparative studies between groups of neonatal units.
极低出生体重儿或早产儿血培养呈阳性通常提示菌血症、败血症，或采样过程中无菌操作失败，这会导致成本增加和住院时间延长。因此，如果对初始风险差异进行校正，医院获得性菌血症的发生率可能是新生儿病房绩效的重要指标。在一项初步研究中，医院获得性菌血症的风险与初始临床风险以及通过婴儿临床风险指数（CRIB）衡量的疾病严重程度相关。医院获得性菌血症被定义为出生48小时后血培养发现细菌且临床上怀疑有感染。1992年至1994年期间，在一个地区新生儿病房的143例婴儿中，有36例（25%）被回顾性确定发生了一次或多次医院获得性菌血症。使用回归分析技术建立了具有生物学合理性的模型。在校正风险期后，医院获得性菌血症与出生孕周和CRIB独立相关。死亡与CRIB独立相关，但与医院获得性菌血症无关。CRIB可能与其他解释变量一起，有助于建立更全面的死亡和医院感染预测模型。这些模型可能有助于未来对新生儿病房组进行风险校正后的比较研究。
