新生儿重症监护病房耐甲氧西林金黄色葡萄球菌定植率和危险因素分析

摘要

Objective To analyze the prevalence and risk factor of methicillin-resistant Staphylococcus aureus (MRSA) skin colonization in neonatal intensive care unit (NICU).Methods One thousand six hundred and seventyeight newborns (938 boys and 740 girls) in NICU were selected,with a mean age of (5.9 ±6.4) days,ranging from 1 to 28 days.Nasal swabs were collected by medical cotton and Staphylococcus aureus (SA) was isolated.All of SA was detected and the mecA gene was detected to determine MRSA through PCR method.The rate of MRSA skin colonization was recorded,and the correlation was analyzed between the rate of MRSA skin colonization and some parameters.The rates of MRSA skin colonization of different time points were compared.Results In NICU,the rate of SA and MRSA skin colonization were 21.10％ (354/1678 cases) and 3.69％ (62/1678 cases),respectively.With the prolongation of hospital stay,the rate of MRSA skin colonization increased,in the order of 7 d ＞ 3 d ＞ 1 d,and the differences were statistically significant (P ＜ 0.05).But the rates of MRSA skin colonization had no significant difference between 7 d and 14 d (P ＞ O.05).Logistic regression analysis showed negative correlation between gestational age,weight,and Apgar scores with MRSA skin colonization but positive correlation between surgery or invasive procedures and antibiotics exposure with MRSA skin colonization.Conclusions Newborns in NICU have high rate of MRSA skin colonization.With the prolongation of hospital stay,the rate of MRSA skin colonization has an increase within 7 days.Gestational age,weight,Apgar scores,surgery or invasive procedures and antibiotics exposure are risk factors of newborn MRSA skin colonization.%目的 分析NICU中耐甲氧西林金黄色葡萄球菌(MRSA)皮肤定植率和危险因素.方法 选取NICU收治新生儿1678例,其中男938例,女740例；日龄1～28 d,平均(5.9±6.4)d.使用无菌棉签采集新生儿鼻翼两侧和鼻腔底部标本,行金黄色葡萄球菌(SA)培养和鉴定.采用PCR法检测mecA基因以鉴定MRSA.统计SA和MRSA皮肤定植率,比较不同住院时间MRSA皮肤定植率的差异,分析MRSA皮肤定植与相关参数的相关性.结果 NICU中新生儿SA和MRSA皮肤定植率分别为21.10％(354/1678例)和3.69％ (62/1678例).随住院时间的延长(住院1、3、7d),新生儿MRSA皮肤定植率明显增加,差异具有统计学意义(P＜0.05),但住院7d和14 d MRSA皮肤定植率差异无统计学意义(P＞0.05).Logistic回归分析显示:胎龄、体质量和Apgar评分与MRSA皮肤定植率呈负相关,而手术或侵入性操作和抗生素使用与MRSA皮肤定植率呈正相关.结论 NICU新生儿MRSA皮肤定植率较高,住院7d内其定植率随住院时间延长而增加；MRSA皮肤定植与新生儿胎龄、体质量、Apgar评分、手术或侵入性操作和抗生素使用密切相关.