新冠肺炎疫情防控期间儿童重症医学科医院感染特征及影响因素分析

Analysis of the Characteristics and Influencing Factors of Hospital Infections in the PICU during the COVID-19

摘要: 目的：回顾性分析新冠肺炎疫情防控期间青岛大学附属医院儿童重症医学科(pediatric intensive care unit, PICU)医院感染特征及危险因素，为保护易感人群、降低住院患者医院感染率、合理选择抗菌药物控制医院感染提供科学依据。方法：以青岛大学附属医院儿童重症医学科新冠肺炎疫情防控期间(2020年1月1日至2022年12月31日)住院患者为研究对象。收集患者一般资料、医院感染部位、医院感染病原菌及来源、抗菌药物应用情况及出院结局等，计算医院感染率，分析医院感染流行特点及危险因素。结果：新冠疫情防控期间PICU收治住院时间 ≥ 48小时患者共925例，其中男性524例，女性401例，年龄为24天至16岁，中位年龄为2岁，住院时间中位数为7天。共发生医院感染71例，千日医院感染发病率为8.35‰，三年中年医院感染发生率分别为3.3%、6.7%、6.9%，无统计学差异(P > 0.05)。感染部位以呼吸道感染、血流感染为主。病原菌标本来源前三位为痰液、静脉血及中段尿。共分离出病原菌59株，包括革兰阴性菌34株，革兰阳性菌17株，真菌8株。分离多重耐药菌(multidrug resistant organism, MDRO)前三位为鲍曼不动菌、金黄色葡萄球菌、屎肠球菌。患者年龄、PICU住院时间、住院期间危重病例评分、血制品输注、肠外营养、糖皮质激素冲击治疗、深静脉置管、胃管、尿管、引流管及有创呼吸机辅助通气与PICU医院感染有关(P < 0.05)。PICU住院时间 > 7天、血制品输注、静脉置管为医院感染独立危险因素(OR值分别为3.600、1.897、3.921；95%CI分别为1.013~6.774、1.024~3.514、1.955~7.864)。结论：新冠疫情防控期间PICU收治患者异质性较大，以小年龄段婴幼儿为主。三年医院感染发生率上升，但无统计学差异。PICU医院感染高发部位为呼吸道、血流感染。医院感染病原体检出革兰阴性菌高于革兰阳性菌，不同感染部位分布的病原菌种类具有差异性，应针对其病原采用合适抗菌药物治疗。PICU住院时间 > 7天、血制品输注、静脉置管为PICU发生医院感染独立危险因素，临床上应积极治疗原发病，严格把握输血指征，减少侵入性操作，严格无菌操作，对具有高危因素患者加强护理和监测，防治医院感染。

Abstract: Objective: To retrospectively analyze the characteristics and risk factors of nosocomial infections in the Pediatric Intensive Care Unit (PICU) of Qingdao University Affiliated Hospital during the COVID-19 epidemic prevention and control period, and to provide a scientific basis for protecting susceptible populations, reducing the nosocomial infection rate of inpatients, and rationally selecting antibiotics to control nosocomial infections. Methods: The inpatients of the PICU of Qingdao University Affiliated Hospital during the COVID-19 epidemic prevention and control period (from January 1, 2020 to December 31, 2022) were selected as the research subjects. General patient information, nosocomial infection sites, pathogenic bacteria and their sources, the application of antibiotics, and discharge outcomes were collected. The nosocomial infection rate was calculated, and the epidemic characteristics and risk factors of nosocomial infections were analyzed. Results: A total of 925 patients with a hospital stay of ≥48 hours were admitted to the PICU during the COVID-19 epidemic prevention and control period, including 524 males and 401 females, with an age range of 24 days to 16 years, a median age of 2 years, and a median hospital stay of 7 days. A total of 71 cases of nosocomial infections occurred, with a nosocomial infection incidence rate of 8.35‰ per 1,000 days. The nosocomial infection rates in the three years were 3.3%, 6.7%, and 6.9%, respectively, with no statistical difference (P > 0.05). The main infection sites were respiratory tract infections and bloodstream infections. The top three sources of pathogenic bacteria specimens were sputum, venous blood, and midstream urine. A total of 59 pathogenic bacteria were isolated, including 34 Gram-negative bacteria, 17 Gram-positive bacteria, and 8 fungi. The top three multidrug-resistant organisms (MDROs) isolated were Acinetobacter baumannii, Staphylococcus aureus, and Enterococcus faecalis. The patient’s age, PICU hospital stay, critical illness score during hospitalization, blood product transfusion, parenteral nutrition, glucocorticoid pulse therapy, deep venous catheterization, gastric tube, urinary catheter, drainage tube, and invasive mechanical ventilation were related to nosocomial infections in the PICU (P < 0.05). A PICU hospital stay > 7 days, blood product transfusion, and venous catheterization were independent risk factors for nosocomial infections in the PICU (OR: 3.600, 1.897, 3.921; 95%CI: 1.013~6.774, 1.024~3.514, 1.955~7.864). Conclusion: The patients admitted to the PICU during the COVID-19 epidemic prevention and control period were highly heterogeneous, with a majority being infants and young children. The nosocomial infection rate increased over the three years, but there was no statistical difference. The high-incidence sites of nosocomial infections in the PICU were the respiratory tract and bloodstream. The detection rate of Gram-negative bacteria was higher than that of Gram-positive bacteria among the pathogenic bacteria, and the types of pathogenic bacteria distributed in different infection sites were different. Appropriate antibiotics should be used for treatment based on the pathogen. A PICU hospital stay > 7 days, blood product transfusion, and venous catheterization were independent risk factors for nosocomial infections in the PICU. Clinically, the primary disease should be actively treated, blood transfusion indications should be strictly controlled, invasive procedures should be reduced, aseptic operations should be strictly followed, and patients with high-risk factors should be closely monitored and cared for to prevent nosocomial infections.