新生儿社区获得性呼吸道感染诊疗路径单中心实践研究
The practice of clinical pathway for community-acquired respiratory tract infection in neonates in a single tertiary hospital
黄鸿眉 1徐晨光 2黄海波 2薛银 2易艳芝2
作者信息
- 1. 100045,国家儿童医学中心首都医科大学附属北京儿童医院保健中心;518048 广东,香港大学深圳医院新生儿病房
- 2. 518048 广东,香港大学深圳医院新生儿病房
- 折叠
摘要
目的 分析新生儿社区获得性呼吸道感染的临床特点及诊疗,探讨抗感染治疗在单中心的规范应用及感染控制效果.方法 2014年1月—2015年12月期间本中心收诊住院的所有社区获得性呼吸道感染的新生儿,回顾性分析其临床特点、病原学特征及诊疗过程,对诊疗选择和诊疗效果进行评价研究.结果 49例患儿中,呼吸道病毒感染的检出率为59.2％(29/49),病毒感染中呼吸道合胞病毒占80.7％(21/26);呼吸道细菌感染的检出率为18.4％(9/49),呼吸道病毒合并细菌感染检出率4.1％(2/49).病毒感染组与细菌感染组患儿相比,具有较高的阳性接触史(76.9％比30.0％,P＜0.05),出现发热症状的比例较少(23.1％比60.0％,P=0.053).所有患儿治疗用抗生素的使用率为26.5％,病毒感染组和细菌感染组的治疗用抗生素使用率差异显著(0比100％,P＜0.05).两组患儿NICU收治率无明显差异(11.5％比20.0％,P＞0.05),均好转或治愈出院,7 d内再入院率均为0.所有呼吸道病毒感染患儿院内接受呼吸道隔离,院内呼吸道病毒感染率为0.结论 新生儿社区获得性肺炎的标准化临床管理方案的实施能够有效对不同病原体感染的患儿进行鉴别诊断和精细化诊疗,减低抗生素的应用比例和时间,规范抗生素的使用;以全院和病区感染控制监测结果为依据的抗生素选择,明确的抗生素引入和撤退标准,准确及时的病原体检测,社区呼吸道接触病史和新生儿病房的呼吸道疾病感染控制是新生儿社区获得性呼吸道感染诊疗的重要环节.
Abstract
Objective To analyze the clinical presentations as well as diagnosis and treatments of community acquired respiratory infections in neonates,and explore appropriate anti-infection therapeutic strategies in a tertiary hospital.Methods Neonates with community-acquired respiratory infection admitted to the neonate center of the study hospital were included in this retrospective study.Clinical features,pathogens,treatment,and prognosis of the patients were described,and the differences in typical characteristics were compared between patients with viral infection and those with bacterial infection.Results In total,49 neonates were included.The detection rate of respiratory virus infection was 59.2％(29/49),in which respiratory syncytial virus accounted for 80.7％(21/26).The detection rate of respiratory bacterial infections was 18.4％(9/49),and the detection rate of respiratory virus combined with bacterial infections was 4.1％(2/49).Compared to patient with the bacterial infection,those with viral infection had a higher proportion of positive contact history(76.9％vs 30.0％,P＜0.05)and a lower proportion of fever symptoms(23.1％vs 60.0％,P=0.053).Antibiotics was used in 26.5％of the patients,and there was a significant difference between patients with viral infection and those with bacterial infection(0 vs 100％,P＜0.05);there was no significant difference in NICU admission rates between the two groups(11.5％vs 20.0％,P＞0.05),and all neonates admitted to NICU were either cured or improved.The readmission rate within 7 days was 0.All patients with respiratory virus infection received respiratory isolation,with a respiratory virus infection rate of 0.Conclusion The implementation of standardized clinical management plans for community-acquired pneumonia in neonates can effectively differentiate and refine the diagnosis and treatments,reduce the proportion and duration of antibiotic use,and improve standardized use of antibiotics.Selection of antibiotics based on infection control monitoring,clear standards for introduction and withdrawal of antibiotics,accurate and timely detection of pathogens,community respiratory contact history,and respiratory disease infection control in neonatal wards are important in the diagnosis and treatment of community-acquired respiratory tract infections in newborns.
关键词
社区获得性呼吸道感染/新生儿/诊疗/病原体/感染控制Key words
community-acquired respiratory infection/neonate/treatment/pathogen/infection control引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据