宋伟鸿 汤有才 张谦

[摘要] 目的 研究入NICU前及NICU內获得性感染的病原菌流行及分布。 方法 在MIMIC-Ⅲv1.4数据库中收集NICU中7870例新生儿临床资料，对新生儿微生物培养结果阳性病例进行回顾性分析。用STATA软件进行数据分析处理。 结果 符合纳入标准研究对象共348例，其中入NICU前感染46例（0.58%）;NICU内感染302例（3.84%）。入NICU前与NICU获得性病原菌感染相比，性别、出生体重差异有统计学意义（P<0.05）。NICU获得性感染样本来源上呼吸道、下呼吸道发生率显著高于入NICU前感染的;NICU获得性感染样本来源血液显著低于入NICU前感染（P<0.05）。入NICU前感染的病原菌，革兰阳性菌为主;革兰阳性菌感染中以链球菌最为常见;革兰阴性菌感染中以大肠杆菌为主;其余较为分散。对于NICU内获得的感染，革兰阳性菌为主，以凝固酶阴性葡萄球菌最常见。余克雷伯杆菌、阴肠沟杆菌、柠檬酸杆菌、鲍曼不动杆菌、变形杆菌、黄单胞菌、艰难梭菌、粪肠球菌及肠球菌均为NICU获得性感染，未在入NICU前感染病原菌中分布。 结论 入NICU前及NICU内获得性感染的病原菌种类、分布、病因及致病力存在明显差异。临床治疗时应明确病原菌是入NICU前还是NICU内获得性感染的感染来源，根据药敏试验合理选择抗生素，有效控制病情发生发展，改善患儿预后。

[关键词] NICU;新生儿感染;病原菌;医院感染

[中图分类号] R181.3          [文献标识码] B          [文章编号] 1673-9701（2021）28-0154-04

Distribution and prevalence of pathogenic bacteria of acquired infection before entering NICU and in NICU

SONG Weihong   TANG Youcai   ZHANG Qian

Department of Pediatrics， the Fifth Affiliated Hospital of Zhengzhou University， Zhengzhou   450000， China

[Abstract] Objective To investigate the prevalence and distribution of pathogenic bacteria of acquired infection before entering neonatal intensive care unit （NICU） and in NICU. Methods The clinical data of 7870 neonates in NICU were collected in Medical Information Mark for Intensive Care （MIMIC）-Ⅲ v1.4 database， and the positive results of neonatal microbial culture were retrospectively analyzed. STATA software was used for data analysis and processing. Results A total of 348 subjects met the inclusion criteria，of which 46 cases were infected before entering NICU （accounting for 0.58%）， while 302 cases were infected in NICU （accounting for 3.84%）. Compared with pathogenic bacteria of acquired infection in NICU gender and birth weight were significantly greater than those before entering NICU（P<0.05）.The incidences of NICU acquired infection samples from upper respiratory tract and lower respiratory tract infections were significantly higher than those before entering NICU. The incidence of NICU acquired infection samples from blood was significantly lower than that infected before entering NICU（P<0.05）.Gram-positive bacteria were the main pathogenic bacteria infected before entering NICU. Streptococcus infection was the most common in Gram-positive bacterial infection. Escherichia coli infection was the main infection of Gram-negative bacteria. The rest were scattered. For the infections acquired in NICU， Gram-positive bacteria were the most common pathogenic bacteria，in which coagulase-negative Staphylococcus were the most common. Klebsiella pneumoniae，Enterobacter cloacae， Citrobacter spp.，Acinetobacter baumannii， Proteus spp.，Xanthomonas spp.，Clostridium difficile，Enterococcus faecalis and Enterococcus were all the pathogenic bacteria of acquired infections in NICU， which were not distributed in the pathogenic bacteria infected before entering NICU. Conclusion There are significant differences in the species， distribution， etiology and pathogenicity of pathogenic bacteria of acquired infection before entering and in NICU.In clinical treatment， it should be clear whether the pathogenic bacteria are infected before entering NICU or the source of acquired infection in NICU. According to the drug sensitivity test， antibiotics should be selected reasonably，so as to effectively control the occurrence and development of disease and improve the prognosis of children.

[Key words] Neonatal intensive care unit; Neonatal infection; Pathogenic bacteria; Nosocomial infection

新生儿感染是重要的公共性问题，在新生儿重症监护病房（Neonatal intensive care unit，NICU）内，感染增加新生儿期发病率、死亡率、住院时间、费用等[1]。NICU中新生儿感染可分为入NICU前感染和NICU内获得性感染（NICU医院内感染，Nosocomial infection，NI）。重症监护室获得性感染定义为在重症监护室入院后48 h以上发生的感染[2]。本研究的目的是根据从NICU入院的时间长度[>48 h（NICU获得性）或≤48 h（NICU入院）]将NICU病原菌分为NICU获得性（NI）或NICU入院。入NICU前同NICU内获得性的病因不同，病原菌的种类不同，根据微生物学数据进行分类，比较流行病学特点，现报道如下。

1 资料与方法

1.1 一般资料

数据来自MIMIC-Ⅲv1.4，由麻省理工学院开发的公开免费数据集。数据集包含2001—2012年间，麻省理工贝斯以色列迪康医疗中心重症监护患者十几年来的真实医疗数据[4]。该数据库包括（年龄≥16岁）53 423例和7870例新生儿。该数据库可供已完成“保护人类受试者”培训的研究人员访问。本研究的数据来源作者完成了国家卫生研究院的在线培训课程（ID：9234432），获得使用该数据库的资格。由于数据库是建立在结构化查询语言（SQL）的基础上的，本研究使用软件pgAdmin（版本9.6）来提取本研究中的所有研究数据[3-4]。