Analysis Of Clinical Influencing Factors Of Nosocomial Infection In Very Low Birth Weight Infants

Objective:The high risk factors and etiological characteristics of nosocomial infection in very low birth weight infants in our hospital in the past 3 years were retrospectively analyzed,the clinical manifestations and outcomes of nosocomial infection were summarized,and the corresponding prevention and treatment strategies were put forward to reduce the incidence of nosocomial infection.the purpose of this study is to provide a basis for improving the survival rate and quality of life of VLBWI and reducing hospitalization costs and family and social burden.Methods:The data of very low birth weight infants admitted in the Neonatal intensive Care Unit of the first affiliated Hospital of Nanchang University from January 2017 to December 2019 were retrospectively analyzed.The general condition,the first clinical manifestation of infection and the results of laboratory examination were recorded.According to the diagnostic criteria of nosocomial infection,100 cases of VLBWI with nosocomial infection were included in the nosocomial infection group,and those without nosocomial infection were included in the non-nosocomial infection group.To count the incidence of nosocomial infection in VLBWI in our hospital.The first clinical symptoms of nosocomial infection in very low birth weight infants in our hospital were summarized,and the infection sites of children in nosocomial infection group were classified and common infection types were found according to the diagnostic criteria of nosocomial infection.the characteristics of bacteriological culture and drug sensitivity test in nosocomial infection group were summarized so as to analyze the distribution and drug resistance of common pathogens in nosocomial infection in our hospital.The clinical influencing factors leading to nosocomial infection in VLBWI were summarized.Univariate analysis was conducted by using SPSS23.0 statistical software,and the factors with statistically significant differences were selected for further multi-factor Logisitic regressionanalysis to obtain independent risk factors and put forward the relevant nosocomial prevention and treatment strategies.Results:1.Among the 100 very low birth weight infants included in this study,38 cases had 48 nosocomial infections,the infection rate was 38.0%(38/100),and the daily infection rate was 9.8 /1000 Inpatient-days,The main type of infection was lower respiratory tract infection in 27 cases(56.3%),followed by septicemia in 11 cases(23.0%).2.The main pathogens of nosocomial infection in our hospital were Gramnegative bacteria,and the detection rates from high to low were Baumann/Acinetobacter haemolyticus,Klebsiella pneumoniae and Pseudomonas aeruginosa,followed by Gram-positive bacteria.fungal infection is an important pathogen of nosocomial infection in very low birth weight children.3.The results of drug sensitivity test of pathogens in the nosocomial infection group of very low birth weight children in our hospital: the drug resistance of Gramnegative bacteria to antibiotics was in the following order: the first and second generation cephalosporins(50%-88%),the third and fourth generation cephalosporins(0%-50%)and β-lactam enzyme inhibitors(0%-50%),and the resistance rate to aminoglycosides,carbapenem and quinolones was low(0%-40%).The overall drug resistance rate of Baumann / Acinetobacter haemolyticus is low(0%-36%);In addition to the high resistance rate of Klebsiella pneumoniae to the first and second generation cephalosporins(66%-88%),the resistance rate of Escherichia coli to other antibiotics was low(0%-33%).The resistance rate of Escherichia coli to first-and second-generation cephalosporins(50%-75%)and third-and fourth-generation cephalosporins and β-lactam enzyme inhibitors(0%-25%)was higher,and the resistance rate of other antibiotics was low(0%-25%).Pseudomonas aeruginosa had a high resistance rate to β-lactam enzyme inhibitors(0%-60%)and a low resistance rate to other antibiotics(0%-40%).4.Univariate analysis of risk factors of nosocomial infection in very low birth weight infants: birth weight,gestational age,time of PICC catheterization>2 weeks,time of mechanical ventilation ≥ 24 hours,time of parenteral nutrition>2 weeks and length of stay in hospital were significantly different between infection group and non-infection group(P<0.05),which were related to nosocomial infection.Further multivariate Logisitic regression analysis showed that parenteral nutrition>2 weeks(OR 5.82,95%CI 1.46-23.18),PICC catheterization>2 weeks(OR 0.038,95%CI 1.08-13.86),mechanical ventilation time≥24 hours(OR 1.13,95%CI 1.01-1.26)were independent risk factors(P<0.05).5.Among the 38 cases in the nosocomial infection group,27 cases(71.1%)were cured and discharged according to the discharge criteria;the discharge criteria were not met,but the vital signs were stable,and the family members asked for discharge and 7 cases(18.4%)were lost after discharge.There were 3 cases(7.9%)who did not meet the discharge standard and were expected to be in danger of life or poor prognosis after discharge,of which 2 cases were referred to other hospitals for surgical treatment because of the diagnosis of NEC,1 case had NEC without surgical treatment,and 1 case died(2.6%).Conclusion:1.Very low birth weight infants have a high incidence of nosocomial infection and should become an important monitoring group for clinicians.2.Respiratory system is the most common type of nosocomial infection of VLBWI in our hospital,followed by blood system.When infection occurs,poor mental reaction,dark skin or skin pattern,apnea,feeding intolerance,abdominal distension,repeated jaundice and body temperature fluctuation are the first clinical manifestations.When infection occurs,children may appear one or more clinical manifestations in the early stage.Once such manifestations occur in the process of clinical treatment,it is necessary to guard against infection.3.The distribution of pathogens in our hospital is mainly Gram-negative bacteria,followed by Gram-positive bacteria.Fungi account for a certain proportion in VLBWI.A full understanding of the distribution and drug resistance of pathogenic bacteria in our hospital can make effective strategies for the use of antibiotics and reduce the production of multi-drug-resistant bacteria.4.The related factors of nosocomial infection in very low birth weight infants were birth weight,gestational age,time of PICC catheterization,time of mechanical ventilation,time of parenteral nutrition and length of stay.PICC catheterization time,mechanical ventilation time and parenteral nutrition time are the most important risk factors for nosocomial infection,so preventing preterm delivery,avoiding or reducing invasive operation,extubation as soon as possible,reasonable parenteral nutrition strategy,shortening hospital stay and strengthening hand hygiene are important measures to reduce the incidence of nosocomial infection.