| Ventilator-associated pneumonia(VAP) was considered ventilator-associated, if it developed 48 hours after mechanical ventilation, unless the clinical evidence strongly suggested otherwise. The time of onset of VAP after mechanical ventilation was used to define as early-onset VAP(< 5 d) or late-onset VAP (≥5 d). Although there have been many studies about VAP since Lareau et al analyzed factors associated with the onset of pneumonia in mechanical ventilated patients in the 1970s, new problem still emerges one after one and presents challenge to clinicians to treat with VAP.The onset of VAP may due to, the severity of patients admited to ICU, inhibition of immunologic function, respiratory tract defense mechanics impairment after tracheal intubation, reflux and aspiration of gastric contents, crossinfection, frequent ventilator circuit changes, prolonged mechanical ventilation etc.Although great efforts have been made both on keeping the ventilation equipments sterilized and treatment with ventilator-depedent patients to decrease nosocomial infection, 8-28% patients who received mechanical ventilation developed VAP yet. The frequency of nosocomial pneumonia in ICUs is obviously higher than common ward. Furthermore, tracheal intubation and mechanical ventilation increase the risk of pneumonia onset by 3-10 fold. The overall mortality attributed to VAP had been estimated at 11 % , but in several special conditions or with dangerous pathogens infection, the mortality can reach as high as 76%.The causative pathogens of VAP vary widely depending on different conditions such as, underlying diseases, the duration of ICU stay etc. Most pathogens of VAP include gram-negative bacilli(GNB). More recently , however, some investigators had reported that gram-positive bacteria have become increasingly more common , the percentage of gram-positive cocci especially methicillin-resistant Staphylococcus aureu (MRSA), methicillin-resistant Staphylococcus epidermidis(MRSE) and enterococci increased, meanwhile the percentage of GNB decreased, for example, former commonly seen GNB such as Pseudomonas aeruginosa was less frequent in several adult ICUs.The newborns and infants with congenital heart defect should receive corrective cardiac surgery at proper time. The majority of them will, if successfully treated, return to a normal productive life. VAP represents an important cause of mortality in this population and increases hospitalization costs.There was few reports about epidemiology of VAP in infants after cardiac surgery. The causative pathogens maybe multi-resistant because preoperative recurrentpneumonia and prior administration of antibiotics in these patients. The primary aim of this study was to describe the epidemiology of VAP in infants after cardiac surgery from June 1999 to June 2002 in our hospital. Special emphasis will be directed towards the trend of the changing distribution of the pathogen and its antibiotic resistance pattern during the last 3 years.MethodsSetting This was a retrospective study using prospectively collected data performed atthe pediatric cardiovascular surgical ICU, Affiliated Children's Hospital, ZhejiangUniversity,China.Patients Data were collected on 311 consecutive infants (aged from 8 days to 12months) with congenital heart defect(CHD) who underwent open-heart surgery in ourhospital between June 1999 and June 2002 .SamplingSurveillance Samples: All patients were monitored for VAP after cardiac surgery by clinical standards and also by cultures of endotracheal aspirate. The technique of endotracheal aspiration was a simplified nonbronchoscopic diagnostic procedure(a blind procedure via a sterile suction catheter).Diagnostic Samplings: Ventilator-associated pneumonia (VAP) was considered ventilator- associated, if it developed 48 hours after mechanical ventilation, unless the clinical evidence strongly suggested otherwise. VAP was defined as the presence of anew or progressive roentgenographic infiltrate developed 48h after m...
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