Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related.
Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related.
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DOI：
10.1186/1471-2431-5-22
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发表时间：
2005-07-08
期刊：
影响因子：
2.4
通讯作者：
Canadian Neonatal Network
中科院分区：
文献类型：
--
作者：
Aziz K;McMillan DD;Andrews W;Pendray M;Qiu Z;Karuri S;Lee SK;Canadian Neonatal Network
医院感染(NI)，尤其是血或脑脊液细菌培养阳性，是新生儿重症监护病房(NICU)发病率的主要原因。不同NICU之间的医院感染率似乎有很大差异。这项研究的目的是确定NI的风险因素，以及加拿大NICU中NI率的风险调整后的变化。从1996年1月至1997年10月，17个加拿大新生儿重症监护室提交了有关人口统计、干预措施、疾病严重程度和医院感染率的数据。4天大时入院的婴儿也包括在内。医院感染定义为住院48小时后血或脑脊液培养阳性。3253例1500g婴儿中765例(23.5%)和13228例婴儿≥1500g中328例(2.5%)至少发生一次医院感染。95%以上的病例为院内菌血症所致。主要发病率在有NI的人中比没有NI的人中更常见。婴儿≥1500g的死亡率与医院感染的相关性更强，但对婴儿和1500g的死亡率没有影响。多因素Logistic回归分析显示，婴儿和1500g的医院感染的危险因素包括妊娠29周、出生儿状态、出生后第1天视力增加、机械通气和肠外营养。当NICU与婴儿和1500克的婴儿进行比较时，与参考地点相比，NICU发生NI的优势比从0.2(95%可信区间[CI]0.1到0.4)到8.6(95%CI 4.1到18.2)。在对风险因素进行调整后，这一趋势持续存在，在较大的婴儿中也发现了这种趋势。加拿大NICU的医院感染率差异很大，即使在对已知的危险因素进行调整后也是如此。这意味着这种差异是由于临床实践的差异，因此可能会受到改变实践的干预措施的影响。
Nosocomial infection (NI), particularly with positive blood or cerebrospinal fluid bacterial cultures, is a major cause of morbidity in neonatal intensive care units (NICUs). Rates of NI appear to vary substantially between NICUs. The aim of this study was to determine risk factors for NI, as well as the risk-adjusted variations in NI rates among Canadian NICUs. From January 1996 to October 1997, data on demographics, intervention, illness severity and NI rates were submitted from 17 Canadian NICUs. Infants admitted at <4 days of age were included. NI was defined as a positive blood or cerebrospinal fluid culture after > 48 hrs in hospital. 765 (23.5%) of 3253 infants <1500 g and 328 (2.5%) of 13228 infants ≥1500 g developed at least one episode of NI. Over 95% of episodes were due to nosocomial bacteremia. Major morbidity was more common amongst those with NI versus those without. Mortality was more strongly associated with NI versus those without for infants ≥1500 g, but not for infants <1500 g. Multiple logistic regression analysis showed that for infants <1500 g, risk factors for NI included gestation <29 weeks, outborn status, increased acuity on day 1, mechanical ventilation and parenteral nutrition. When NICUs were compared for babies <1500 g, the odds ratios for NI ranged from 0.2 (95% confidence interval [CI] 0.1 to 0.4) to 8.6 (95% CI 4.1 to 18.2) when compared to a reference site. This trend persisted after adjustment for risk factors, and was also found in larger babies. Rates of nosocomial infection in Canadian NICUs vary considerably, even after adjustment for known risk factors. The implication is that this variation is due to differences in clinical practices and therefore may be amenable to interventions that alter practice.