长庚配对病例对照研究发现肠外营养是新生儿迟发脓毒症的高风险因素

　　新生儿血流感染（BSI）是早产儿于新生儿重症监护病房（NICU）常见的并发症，可造成迟发脓毒症且死亡率相对较高（约5～15%），而台湾地区BSI发生率为4～11.4%，而死亡率高达7.2～20%。

　　由于目前台湾地区仍缺乏针对血流感染的全面研究，长庚大学医学院、桃园长庚纪念医院、桃园长庚儿童医院、厦门长庚医院利用配对病例对照研究分析了可能的风险因素。

　　该研究利用血流感染数据库分析血流感染患者与健康受试者之间的差异，并记录出生体重、妊娠年龄、性别、爱普格（Apgar）新生儿评分数值及出生时间。

　　结果发现，共有164例婴儿发生血流感染，主要为凝固酶阴性葡萄球菌（28.7%）、金黄色葡萄球菌（16.5%）、肺炎克雷伯菌（14.6%）、念珠菌属（6.7%）感染造成。

　　此外，条件逻辑回归多变量分析证实，静脉营养、脑室内出血为两大风险因素，风险分别增加6.07倍（95%置信区间：1.14～32.32，P=0.034）、2.68倍（95%置信区间：1.20～5.99，P=0.017）。

　　因此，研究者认为肠外营养为迟发脓毒症的高风险因素，建议在NICU应注意给予肠外营养的时机，以提高整体医疗质量。

J Microbiol Immunol Infect. 2016;49(3):430-5.

Risk factors of late-onset neonatal sepsis in Taiwan: A matched case-control study.

Kung YH, Hsieh YF, Weng YH, Lien RI, Luo J, Wang Y, Huang YC, Chen CL, Chen CJ.

College of Medicine, Chang Gung University, Taoyuan, Taiwan; Chang Gung Children's Hospital, Taoyuan, Taiwan; Chang Gung Memorial Hospital, Taoyuan, Taiwan; Xiamen Chang Gung Hospital, Xiamen, People's Republic of China.

BACKGROUND: Infants in a neonatal intensive care unit (NICU) have a higher incidence of bloodstream infections (BSIs) than any other pediatric or adult population. The predisposing factors have not been comprehensively evaluated in this population in Taiwan.

METHODS: A retrospective matched case-control study was conducted in the NICUs of a teaching hospital in Taiwan. The case patients were identified from a staff-maintained electronic database containing the records of BSIs from July 2003 to June 2006. The case patients and the control patients (who did not develop BSI during their NICU stay) were 1:1 matched by birth weight, gestational age, gender, Apgar score, and date of birth.

RESULTS: A total of 164 infants with culture-proven BSI were identified. Of these, 74 (45.1%) infants were female. The mean gestational age and birth weight were 30.7 ± 0.7 weeks and 1512 ± 804 g, respectively. The common etiologic pathogens included coagulase-negative staphylococci (28.7%), Staphylococcus aureus (16.5%), and Klebsiella pneumoniae (14.6%). Candida spp. accounted for 11 (6.7%) episodes. Two independent factors associated with BSIs in the neonates, as identified by multivariate analysis using conditional logistic regression, were the use of parenteral nutrition (matched odds ratio [mOR], 6.07; 95% confidence interval [CI], 1.14-32.32; p = 0.034) and intraventricular hemorrhage (mOR, 2.68; 95% CI, 1.20-5.99; p = 0.017).

CONCLUSION: Parenteral nutrition was a significant and independent risk of late-onset neonatal sepsis. This risk should be considered when implementing early parenteral nutrition in NICUs.

KEYWORDS: Bloodstream infections; Neonates; Parenteral nutrition; Risk factors

PMID: 24274960

DOI: 10.1016/j.jmii.2013.10.001