Prevention and treatment of neonatal nosocomial infections.
Prevention and treatment of neonatal nosocomial infections.
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DOI：
10.1186/s40748-017-0043-3
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Ramasethu J
中科院分区：
文献类型：
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作者：
Ramasethu J
医院或医院获得性感染威胁着新生儿重症监护病房婴儿的存活和神经发育结果，并增加了护理成本。早产儿特别脆弱，因为他们经常接受侵入性手术，并依赖中央导管提供营养，依靠呼吸机提供呼吸支持。预防医院感染是患者安全的关键，而且总是需要多学科的方法。没有捷径可走。患者接触前后的手卫生是最重要的措施，然而，遵守这一简单措施可能并不令人满意。以酒精为基础的洗手液对许多微生物有效，而且与普通或含有杀菌剂的肥皂相比是有效的。使用母亲母乳是降低感染率的另一种廉价和简单的措施。通过使用益生菌、益生菌和合生菌来复制母亲母乳的抗感染特性的努力取得了不同程度的成功，正在进行乳铁蛋白的试验，乳铁蛋白是一种铁结合乳清蛋白，在初乳中大量存在。使用外源性免疫球蛋白提高早产儿免疫球蛋白水平的尝试并未显示出显著减少医院感染的作用。在过去的十年里，导管相关感染的发生率已经取得了改善，从插入到维护的每一个细节都得到了细致的关注，一些中心报告说，这类感染的发生率为零。其他医院感染，如呼吸机获得性肺炎和金黄色葡萄球菌感染仍然存在问题，多药耐药微生物的暴发继续造成灾难性后果。对感染的管理是基于新生儿病房和社区中微生物的概况，需要有针对性的治疗来控制疾病，而不会导致更多耐药菌株的发展。
Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more resistant strains.