| Objec tive :Summarize the mechanical ventilation cases in NICU with sputum culture positive by the information of clinical feature, pathogen distribution and drug sensitivity test, analyze the risk factors of ESBLs positive bacteria infections, to provide the tantibiotics reatment for the case with MV in NICU.Methods:Retrospective analyze 60 the cases with MV and positive sputum culture in NICU of Chongqing Medical University Children's Hospital, summarize its primary disease, the cause of MV, the time of MV, the prognosis, pathogenic bacteria and drug sensitivity test, and study the the high risk of ESBLs positive bacteria infections.Results:1.The cause of MV, progressive respiratory distress 16.7%, respiratory failure 65.0%, pulmonary hemorrhage 6.7%, apnea 6.7%, pneumothorax 3.3%, congenital heart surgery 1.6%. The cases for mechanical ventilation 2 times was 11.7% of patients in MV(7/60).2.53 secondary mechanical ventilation cases, MV time <2d 19 cases (≤24h 9 cases), 2d~7d 29 cases, >7d 5 cases, the MV time was 3.39±2.78d. The MV time of the secondary mechanical ventilation cases was 6.71±2.51d.3.In 78 bacterial strain, G- bacteria 85.9%, including klebsiella pneumoniae 35.9%, pseudomonas aeruginosa 17.9%, acinetobacter baumannii 12.8%, E.coli 5.1%, Enterobacter cloacae 5.1%, G+ bacteria 85.9%, Fungi 10.3%. 9 sputum was mixed infection, the most common Klebsiella pneumoniae and Pseudomonas aeruginosa mixed infections ;7 cases were detected the same pathogen for 2 times.4.Fungal infection before MV, duration of MV<48h, duration of MV≥48h and off ventilated respectively was 0%, 6.3%, 11.8%, 18.8%; after MV≥48h, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Stenotrophomonas maltophilia infection increased.5.The drug resistant rates of the common G- bacteria to ampicillin, cephazoline were 100%, to Amoxicillin/clavulanic acid was 96.4%-100%, to Ampicillin/sulbactam, cefotaxime, ceftazidime, tetracycline, chloramphenicol and cotrimoxazole were 42.9%-100%, to piperacillin tazobactam was 35.7%-67.8%, to meropenem and imipenem were 11.1% -28.6%, and to polymyxin was 0% -22.2%. 6.The rate of ESBLs positive bacteral was 44.8%(30/67), higher detection rate of pathogen was Klebsiella pneumoniae 85.7%(24/2 8 ).7.Admission time longer than the 7d and used the third-generation cephalosporins were the risk factors of ESBLs producing bacteria infection (P<0.05), relative risk were respectively 9.17 and 6.02.8.55 cases of children were eventually successfully off ventilation, 5 cases died, mortality rate was 8.3%, the death cases were less than 30 hours of age, were low birth weight children, including four cases of birth weight less than 1500g. The case with NRDS in MV has good prognosis, successfully off ventilation, no reintubation and mortality. The length of stay was 18.9±12.7d.Conclusion :1.The most cause of MV is respiratory failure, followed by progressive dyspnea, pulmonary hemorrhage, and apnea. Respiratory failure were more common in reintubation cases. The common cause of secondary mechanical ventilation cases was respiratory failure.2.The average MV time of the cases for mechanical ventilation 2 times is more than the cases for mechanical ventilation 1 times.3.In pathogenic bacterium, G- bacteria especially klebsiella pneumoniae were the most common, the common nosocomial infection bacterial is increased after the MV.4.The drug resistant rates of G- bacteria to penicillins, cephalosporins, and monocyclicβ-lactam antibiotic were high, however, their compound of addingβ-lactamase inhibitor agents was relatively low resistance, and sensitive to carbapenem antibiotics but there is also resistance, the most sensitive to polymyxin.5.Admission time longer than the 7d and used the third-generation cephalosporins were the risk factors of ESBLs producing bacteria infection.6.After aggressive treatment, the majority got good prognosis. The patients with NRDS treated by MV has a good prognosis. The MV age small and low birth weight infants on MV has a poor prognosis.
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