隨著醫療照護科技的進展，愈來愈多懷孕週數小於37週，出生體重小於2500公克低體重早產兒，住進新生兒加護病房接受密切照護。研究報告指出，院內血流感染是新生兒加護病房最常見而致命的感染，特別是低體重早產兒。為瞭解低體重早產兒院內血流感染發生率、危險因子及其對醫療費用的影響，做為院內感染控制監控的參考，進行本研究。
　　本研究目的在1.了解新生兒加護病房低體重早產兒併發院內血流感染發生率及菌種分佈。2.分析新生兒加護病房低體重早產兒的院內血流感染危險因子。3.探討院內血流感染對低體重早產兒之預後及住院天數、醫療費用的影響。
　　研究為一回溯性研究，收集1996年至2000年715名住進南部某一醫學中心新生兒加護病房，出生年齡小於一個月，無其他重大外科疾患，且住院時間大於48小時之低體重早產兒。自醫院資訊系統取得符合研究之個案，查閱五年期間所有研究對象病歷記錄，收集人口學特性、醫療裝置措施及其他危險因子、並由醫院醫療事務室及資訊室電腦檔案取得病患該次住院醫療費用進行研究。依不同出生體重組別，進行菌種感染發生率，以性別、懷孕週數、出生體重、出生評估指數、生產方式，及臍導管、中心靜脈導管、全靜脈營養輸液及呼吸器等醫療裝置使用等變項，先進行單變項分析。單變項分析具顯著差異之變項，以邏輯迴歸模式進行多變項迴歸分析。
　　研究結果發現，院內血流感染絕大部分（82%）發生在小於1500公克極低體重早產兒，不同出生體重早產兒感染發生密度隨著體重的降低而升高，自2000公克以上低體重早產兒每千住院人日5.7，至小於1000公克極度低體重早產兒每千住院人日20.2。血流感染病原菌以凝集脢原陰性葡萄球菌的感染發生密度最高（7.69‰），其次金黃色葡萄球菌（1.74‰）。148例院內血流感染個案，有26例死亡（17.6﹪），其中11例可直接歸因於血流感染死亡，血流感染致死率為7.4﹪。致病菌中因金黃色葡萄球菌致死5例（致死率22.7%），凝集脢原陰性葡萄球菌2例（致死率2.5%）。
　　經多變項迴歸分析發現，院內血流感染與出生體重（<1000公克 vs >2000公克，OR：3.46，95%CI：1.34-8.92）、全靜脈營養輸液之使用（OR：9.41，95%CI：4.04-21.93）相關。對於1500公克以下存活之極低體重早產兒，發生院內血流感染，其新生兒加護病房住院天數較無院內血流感染增加32天（醫療費用增加44萬元），而1500公克以上存活之低體重早產兒，其新生兒加護病房住院天數較無院內血流感染增加21天（醫療費用增加28萬元）。
　　本研究發現低體重早產兒的出生體重，全靜脈營養輸液使用，是影響院內血流感染危險因子，新生兒加護病房面臨極低體重早產兒的逐年上升，針對極低體重早產兒照護上的特殊性，需要加強此方面的認知與照護上的需求。調整全靜脈營養輸液之使用策略，儘早移除全靜脈營養輸液，以其他方式取代。
　　本研究亦發現，院內血流感染延長低體重早產兒住院天數，增加醫療費用。對高醫療資源耗用的低體重早產兒，確實執行感染控制措施，有助於減少醫療資源之耗用並提昇低體重早產兒臨床照護品質。

　　The number of neonatal patients at risk of acquiring nosocomial infections is increasing because of the improved survival of very low birth weight infants and their needs for invasive monitoring and supportive care.
　　The aim of this study was to investigate the epidemiology of nosocomial bloodstream infections in low birth weight infants in a neonatal intensive care unit (NICU) and to identify the associated risk factors, and its impact on medcal costs.
　　We retrospectively reviewed the preterm infants admitted to the NICU from January 1, 1996 to December 31, 2000 at a medical center in southern Taiwan. Preterm infants aged younger than one month and admitted to the NICU longer than 48 hours were identified from the hospital database.
　　Demographic characteristics, medical procedures, medical costs and pathogens that caused the infection were obtained from charts and hospital admission database.　
Overall, a total of 715 preterm infants were identified. There were 193 episodes of nosocomial bloodstream infections in 148 cases. The incidence density was 20.2‰ for infants of birth weight less than 1,000g and was 5.7‰ for those greater than 2,000g. Throughout the study period, coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the most common blood culture isolates, with incidence density of 7.69‰ and 1.74‰, respectively.
　　By multivariate logistic regression analysis, we found that preterms of birth weight <1000g were 3.5 times more likely to have nosocomial bloodstream infections than those of > 2000g (OR：3.46，95%CI：1.34-8.92). In addition, preterms with total parenteral nutrition usage were approximately 9.5 times more likely to have infections than those without the usage (OR：9.41，95%CI：4.04-21.93).
　　The total hospitalization days for low birth weight preterm infants with nosocomial bloodstream infections all were longer than those without nosocomial bloodstream infections in each birth weight category (p＜0.05). The average length of stay of neonates with nosocomial bloodstream infections who have survived was 19 to 25 days greater than that of uninfected patients in different birth weight categories.
　　Our study has demonstrated that low birth weight, usage of total parenteral nutrition increase the risk of nosocomial bloodstream infections for low birth weight preterms. This study also highlights that nosocomial bloodstream infections increase the medical costs in low birth weight preterms, especially in the extremely low birth weight ones.
　　Knowing the risk factors for the development of bloodstream infections in the NICU is essential for implementation of adequate preventive measures, and further elimination of the extra medical costs due to bloodstream infections.

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