本研究旨在探讨新生儿重症监护病房(neonate intensive care unit，NICU)住院新生儿感染病原菌分布、主要病原菌的耐药情况，并分析新生儿医院感染的危险因素。选取2022年1月—2023年12月南京市妇幼保健院NICU住院的2 812例新生儿的临床资料进行回顾性分析，根据是否发生医院感染分为感染组(453例)和非感染组(2 359例)，分析感染组新生儿血液培养的病原菌分布情况以及主要病原菌的耐药情况，并采用Logistic回归分析新生儿医院感染的危险因素。结果显示：本研究纳入的2 812例NICU住院新生儿中，发生医院感染的有453例(16.11%)，共检出475株病原菌，主要为革兰氏阳性菌(58.32%)。革兰氏阳性菌中，凝固酶阴性葡萄球菌对青霉素C(93.57%)、红霉素(76.61%)及苯唑西林(71.93%)的耐药率较高，但对利福平(8.19%)、呋喃妥因(1.75%)及万古霉素、利奈唑胺敏感；金黄色葡萄球菌对青霉素C完全耐药(100%)，但对利福平、万古霉素等无耐药性。革兰氏阴性菌中，大肠埃希菌对头孢曲松(47.95%)、头孢唑林(41.10%)显著耐药，而肺炎克雷伯菌对头孢他啶(44.64%)、头孢曲松(39.29%)的耐药率高，但两者对亚胺培南、阿米卡星均完全敏感。感染组胎龄<37周、出生体重<2 500 g、分娩方式剖宫产、出生5 min Apgar评分≤7分、窒息抢救、机械通气、胃肠外营养、抗菌药物种类≥2种、抗菌药物使用时间>7 d、ICU入住时长>7 d的比例高于非感染组(P<0.05)。NICU新生儿医院感染以革兰氏阳性菌为主，对青霉素类及红霉素的耐药率高，对万古霉素、利奈唑胺仍敏感。多因素Logistic回归分析结果显示，胎龄<37周、低出生体重、机械通气、抗菌药联用及ICU滞留>7天为NICU新生儿医院感染的独立危险因素。因此，临床须规范侵入性操作及抗菌药物管理，优化高危患儿感染防控策略。

The aim of this study was to explore the distribution of infection pathogens and drug resistance of main pathogens in neonates in neonatal intensive care unit (NICU), and to analyze the risk factors of nosocomial infection. A retrospective analysis was performed on the clinical data of 2 812 neonates in NICU of Nanjing Maternal and Child Health Hospital from January 2022 to December 2023. According to the presence or absence of nosocomial infection, neonates were divided into infection group (453 cases) and non-infection group (2 359 cases). The distribution of pathogens and drug resistance of main pathogens in infection group were analyzed. The risk factors of nosocomial infection were analyzed by Logistic regression analysis. Among 2 812 neonates in NICU, there were 453 cases (16.11%) with nosocomial infection. A total of 475 strains of pathogens were detected, mainly Gram-positive bacteria (58.32%). Among Gram-positive bacteria, coagulase-negative staphylococci had high resistance rates to penicillin C (93.57%), erythromycin (76.61%) and oxacillin (71.93%), but were sensitive to rifampin (8.19%), nitrofurantoin (1.75%), vancomycin and linezolid. Staphylococcus aureus was completely resistant to penicillin C (100%), but had no resistance to rifampicin and vancomycin. Among the gram-negative bacteria, Escherichia coli was significantly resistant to ceftriaxone (47.95%) and cefazolin (41.10%), while Klebsiella pneumoniae was highly resistant to ceftazidime (44.64%) and ceftriaxone (39.29%), but both of them were completely sensitive to imipenem and amikacin. Compared with the non-infection group, the infection group had a significantly higher proportion of infants with gestational age <37 weeks, birth weight <2 500 g, cesarean section, Apgar score ≤7 at 5 min after birth, asphyxia rescue, mechanical ventilation, parenteral nutrition, types of antibiotics ≥2, duration of antibiotic use >7 days, and length of ICU stay >7 days (P<0.05). The main pathogens of nosocomial infection are Gram-positive bacteria in NICU neonates, with high resistance rates to penicillin and erythromycin, but still sensitive to vancomycin and linezolid. Gestational age <37 weeks, low birth weight, mechanical ventilation, combined use of antibiotics and stay time in ICU >7 d are independent risk factors of nosocomial infection. It is necessary to standardize invasive operation and antibiotics management, and optimize prevention and control strategies for high-risk neonates.