Neonatal Nosocomial Infection Monitoring And Risk Factors In A Children’s Hospital

Patients with hospital infection refers to other parts or other pathogen infection in the process of hospital diagnosis and treatment on the basis of the primary disease. With the developing of medical technology, invasive diagnosis and treatment method, the application of hormones and antibiotics therapy are increasing, the incidence of hospital infection were significantly increased at home and abroad. Those infants with immature neonatal immune system, low resistance, and poor ability to adapt to the external environment are the high risk population of hospital infection. Although many breakthroughs on neonatal nosocomial infection have achieved in recent years, there still exists a lot of issues. Firstly, many risk factors may contribute to neonatal nosocomial infection, there are significant difference between different hospitals and areas. Secondly, more targeted treatment measures are required because of complicate etiology. Thirdly, how to monitor the neonatal nosocomial infection effectively still remains controversial for specificity of newborns. This investigation is designed to try to find the answers for above issues. Objectives: To perform an objective monitor and to explore pathogenic characteristics of the neonatal nosocomial infection; to provide clinical basis for prevention and control of neonatal nosocomial infection; and to find risk factors for neonatal nosocomial infection for formulating the prevention and control measures of hospital infection based on the regional background. Methods: A total of 12310 newborn infants who admitted in neonatal department from January 2011 to December 2013, were reviewed. We collected their clinical data such as birth weight, hospitalization days, invasive operation, the date of nosocomial infection, sites of nosocomial infection, antibiotics use, examination of pathogenic bacteria, and so on. Nosocomial infection was observed by objective monitoring, pathogenic characteristics of neonatal nosocomial infection were analyzed. Several different factors which may contribute to neonatal nosocomial infection were analyzed by a case-control study. A mathematic equation was constructed by a logistic regression analysis for predicting prognosis purpose. Results: There were 12310 hospitalized neonatal patients in three years, of which 154 cases occurred nosocomial infection, and the neonatal hospital infection rate was 1.25%. A total of 162 times(1.32%) of infection occurred. The day incidence of hospital infection was 1.18‰. The top three of infection sites was the upper respiratory tract(37.65%), the lower respiratory tract(25.93%), and the digestive tract(17.28%).A total of 132 strains of pathogenic bacteria were isolated from 154 cases with neonatal nosocomial infection, of which 59 strains were gram-positive bacteria(44.7%) mainly by epidermis staphylococcus aureus, enterococcus, hemolysis and staphylococcus aureus, 69 strains of gram-negative bacteria(52.27%) mainly by klebsiella pneumoniae and e. coli and pseudomonas aeruginosa, and 4 strains of fungi and other bacteria(3.03%).Those most of gram-positive bacteria had an extensive drug resistance to penicillin(93.75%- 100.00%), and was highly resistant to macrolides(87.50%-96.88%), and is highly sensitive to glycopeptide antibiotics. Coagulase negative staphylococcus was moderately resistant to second and third generation cephalosporins. Staphylococcus aureus was sensitive to cephalosporins. Those most of gram-negative bacteria were extensively resistant to the second and third generations of cephalosporins(42.86%-100%), moderately resistant to the fourth generation cephalosporins, highly resistant to sulfanilamide(58.33%-80.95%), and sensitive to carbapenems and penicillin.The case-control study indicated that hospital infection was related to the following factors: gestational age(OR=2.006, 95%CI : 1.194-3.370, P=0.008), birth weight(OR=5.924, 95%CI:3.892-9.018, P=0.001), in-hospital days(OR=2.780, 95%CI: 1.783-4.334, P=0.001),and invasive operation(OR=4.909, 95%CI:3.181-7.561, P=0.001). By performing a logistic regression analysis, this study found the birth weight less than 2500 grams, the length of hospital stay more than 10 days, and invasive operation were the risk factors of hospital infection. A mathematic equation, logit(P)=Ln(P/1-P)=-3.558+1.155X2+0.590X3+1.619X4, was constructed for predicting prognosis purpose. Conclusions: Firstly, performing objective monitor and constituting prevention and control measures are in favor of decreasing the chance of nosocomial infection. Secondly, the pathogen monitoring and the rational use of antibiotic are in favor of controlling of bacterial resistance. Thirdly, the birth weight, hospitalization days, invasive operation are the risk factors of hospital infection. Individualized prevention and treatment plan is required when a newborn patient is predicted to have a high probability of hospital infection.