Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit
Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit
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DOI：
10.1097/01.inf.0000199310.52875.10
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发表时间：
2006-02-01
影响因子：
3.6
通讯作者：
Saiman, L
中科院分区：
文献类型：
--
作者：
Graham, PL;Begg, MD;Saiman, L
背景资料：在新生儿重症监护病房（NICU）患者中，20-30%的迟发性脓毒症是由谷物阴性血流感染（BSI）引起的，死亡率为30- 50%。我们调查了极低出生体重（< 1500 g）新生儿重症监护病房（NICU）患者迟发性粒细胞阴性脓毒症的危险因素。方法：我们进行了一项病例对照研究，作为一项为期2年的大型临床试验的一部分，该试验旨在研究手部卫生习惯对医院获得性感染的影响。在该子研究中，1例极低出生体重婴儿患有医院获得性革兰氏阴性BSI;对照受试者，在研究中心和手卫生产品上匹配，从没有革兰氏阴性BSI的患者中随机选择。结果：48例革兰阴性菌BSI患者中，有48例为非革兰阴性菌BSI患者。在多变量分析中，我们发现以下变量与革兰氏阴性BSI显著相关：中心静脉导管插入持续时间> 10天，鼻插管持续气道正压通气使用，H2阻滞剂/质子泵抑制剂使用;和胃肠道pathology.Conclusions：这些分析提供了潜在的策略，以减少革兰氏阴性BSI的见解。NICU患者应尽可能移除导管，并谨慎使用H2阻滞剂/质子泵抑制剂。鼻套管持续气道正压通气与革兰氏阴性菌BSI之间的关系需要进一步研究。胃肠道病理学与革兰氏阴性BSI的关联确定了一个高风险组的新生儿谁可能受益于加强预防策略。
Background: Grain-negative bloodstream infections (BSIs) cause 20-30% of late onset sepsis in neonatal intensive care unit (NICU) patients and have mortality rates of 30-50%. We investigated risk factors for late onset Grain-negative sepsis in very low birth weight (< 1500 g) NICU patients.Methods: We performed a case-control study as part of a larger 2-year clinical trial that examined the effects of hand hygiene practices on hospital-acquired infections. In this substudy, a case was a very low birth weight infant with a hospital-acquired Gram-negative BSI; control subjects, matched on study site and hand hygiene product, were chosen randomly from the patients who did not have Gram-negative BSIs. Potential risk factors were analyzed by Mantel-Haenszel methods and conditional logistic regression.Results: There were 48 cases of Gram-negative BSI. In multivariate analysis, we found that the following variables were significantly associated with Gram-negative BSI: central venous catheterization duration of > 10 days, nasal cannula continuous positive airway pressure use, H2 blocker/proton pump inhibitor use; and gastrointestinal tract pathology.Conclusions: These analyses provide insights into potential strategies to reduce Gram-negative BSIs. Catheters should be removed as possible and H2 blockers/proton pump inhibitors should be used judiciously in NICU patients. The association between nasal cannula continuous positive airway pressure and Gram-negative BSIs requires further investigation. The association of gastrointestinal tract pathology with Gram-negative BSIs identifies a high risk group of neonates who may benefit from enhanced preventative strategies.