Avila-Figueroa C, Goldmann D A, Richardson D K, Gray J E, Ferrari A, Freeman J
Hospital Infantile de Mexico, Dr. Marquez, Mexico DF.
Pediatr Infect Dis J. 1998 Jan;17(1):10-7. doi: 10.1097/00006454-199801000-00004.
Intravenous lipid emulsions and the i.v. catheters through which they were administered were the major risk factors for nosocomial coagulase-negative staphylococcal (CONS) bacteremia among newborns in our neonatal intensive care units a decade ago. However, medical practice is changing, and these and other interventions may have different effects in the current setting.
We determined the independent risk factors for CONS bacteremia in current very low birth weight newborns after adjusting for severity of underlying illness.
We surveyed 590 consecutively admitted newborns with birth weights < 1500 g hospitalized in 2 neonatal intensive care units and conducted a case-control study in a sample of 74 cases of CONS bacteremia and 74 pairs of matched controls. Adjusted relative odds of bacteremia were estimated for a number of attributes and therapeutic interventions in 2 time intervals before CONS bacteremia: any time before bacteremia and the week before bacteremia.
Using conditional logistic regression to adjust for indicators of severity of illness, two procedures were independently associated with subsequent risk of CONS bacteremia at any time during hospitalization: i.v. lipids, odds ratio (OR) = 9.4 [95% confidence interval (CI) 1.2 to 74.2]; and any surgical or percutaneously placed central venous catheter, OR = 2.0 (95% CI 1.1 to 3.9). Considering only the week immediately preceding bacteremia, the independent risk factors were: mechanical ventilation, OR = 3.2 (95% CI 1.3 to 7.6); and short peripheral venous catheters, OR = 2.6 (95% CI 1.0 to 6.5).
During the last decade exposure to i.v. lipids any time during hospitalization has become an even more important risk factor for CONS bacteremia (OR = 9.4). Of these bacteremias 85% are now attributable to lipid therapy. In contrast the relative importance of intravenous catheters as independent risk factors has declined. Mechanical ventilation in the week before bacteremia has emerged as a risk factor for bacteremia.
静脉注射脂质乳剂以及用于输注的静脉导管是十年前我们新生儿重症监护病房中新生儿发生医院获得性凝固酶阴性葡萄球菌（CONS）菌血症的主要危险因素。然而，医疗实践正在发生变化，这些及其他干预措施在当前环境下可能会产生不同的影响。
在调整基础疾病严重程度后，我们确定了当前极低出生体重新生儿发生CONS菌血症的独立危险因素。
我们对2个新生儿重症监护病房中连续收治的590例出生体重<1500g的新生儿进行了调查，并在74例CONS菌血症病例和74对匹配对照的样本中开展了病例对照研究。针对CONS菌血症发生前2个时间段内的一些特征和治疗干预措施，估计菌血症的校正相对比值：菌血症发生前的任何时间以及菌血症发生前的一周。
使用条件逻辑回归调整疾病严重程度指标后，两种操作在住院期间的任何时间均与随后发生CONS菌血症的风险独立相关：静脉注射脂质，比值比（OR）=9.4 [95%置信区间（CI）1.2至74.2]；以及任何外科手术或经皮放置的中心静脉导管，OR =2.0（95%CI 1.1至3.9）。仅考虑菌血症发生前的一周，独立危险因素为：机械通气，OR =3.2（95%CI 1.3至7.6）；以及外周短静脉导管，OR =2.6（95%CI 1.0至6.5）。
在过去十年中，住院期间任何时间接受静脉注射脂质已成为CONS菌血症更重要的危险因素（OR =9.4）。现在这些菌血症中有85%可归因于脂质治疗。相比之下，静脉导管作为独立危险因素的相对重要性已下降。菌血症发生前一周的机械通气已成为菌血症的一个危险因素。
