Analysis Of Risk Factors And Pathogen For Ventilator-associated Pneumonia In Neonates

Objective：Through the analysis on the clinical data of the newborn whowas used the breathing machine by our hospital’s NICU, to investigate the riskfactors， pathogen distribution and drug sensitivity of neonatalventilator-associated pneumonia(VAP)．Methods：Selected the clinical data of all mechanical ventilation(>48h)patients admitted to the neonatology of The Second Hospital of HeBeiMedical University from September2006to February2009．The incidence ofVAP, the risk factors and pathogenic bacteria culture results wereretrospectively analyzed．All patients mechanical ventilated for>48h wereenrolled from admissions to the NICU. The data collected in this studyconsisted of253NICU patients，113VAP and140controls, the group of VAPinclude65cases of neonatal respiratory distress syndrome(NRDS),3cases ofmeconium aspiration syndrome(MAS),89cases of neonatal asphyxia,8casesof pneumonia,2cases of congenital heart disease(CHD),4cases of apnea,5cases of sepsis,3cases of pneumothorax,2cases of empsyxis,2cases ofhypoxic ischemic encephalopathy(HIE). Control group include56cases ofNRDS,7cases of MAS,53cases of asphyxia,35cases of pneumonia,6casesof CHD,7cases of HIE.The diagnosis criteria of VAP：This research will refer to version4《practical neonatology》[1]. Analysis of the content:(1)the incidence of VAPwas studied by multiple regression analysis of relevant factors：gender,gestational age(＜37w、≥37w),birth weight(＜2.5kg、≥2.5kg)，Thenumber of intubation，Mechanical ventilation time, hospital stays. Whether touse immunoglobulin, pulmonary surfactant, parenteral nutrient solution.(2)Investigate the distribution and drug resistance of pathogens ofventilator-associated pneumonia. Statistics： SPSS19.0software package Was used to perform non-conditional logistic regression analysis(univariate analysis and multivariatestepwise logistic regression analysis).Results：253patients with mechanical ventilation in neonatal include113cases ofVAP, the incidence of VAP was44.66%, the group of24cases of death inchildren with VAP, mortality is21.2%, the control group with4cases died,mortality rate2.9%, neonatal VAP risk factors related to the single factorunconditioned Logistic regression analysis of low birth weight, gestational age,mechanical ventilation time, number of endotracheal intubation with statisticalsignificance. Neonatal VAP risk factors related to choose the single factoranalysis of multiple factors regression analysis results showed that low birthweight, mechanical ventilation time and number of endotracheal intubation isthe newborn in the independent risk factors of VAP. In the113cases ofneonatal VAP,97cases of neonatal test positive for etiology,positive rate is85.84％,among which67were gram-negative bacilli, accounted for62.62%,mainly include pseudomonas aeruginosa, acinetobacter baumannii,klebsiella pneumoniae, Gram positive coccus is25cases (23.36%), mainlyinclude staphylococcus aureus; Fungi is15strains, accounting for14.02%.Pathogens and drug susceptibility test showed that resistant strains is graduallyincreased, and pathogenic bacteria is phenomenon of multiple drug resistancefor clinical commonly used antibiotics,only for some of its sensitive toantibiotics.Conclusions:VAP is a complications which seriously impact on children withmechanical ventilation treatment. It is the main reason for neonatalnosocomial infection,Extending the length of hospital stay and increasing cost of treatmenteven death. It has a high morbidity and mortality，and is influence by manyfactors,such as birth weight, gestational age, number of endotrachealintubation. The main pathogenic bacteria of VAP is given priority to with gram-negative bacteria, and there are multiple drug resistance phenomenon.Inorder to prevent the occurrence of VAP hospitalized children, reduce costs,reduce child mortality, reasonable and effective measures must be taken.According to the susceptibility of the rational use of antibiotics. At the sametime, because of Fungi cultivation rate is increasing, it is important forprevention and treatment of fungal pneumonia the reasonable use of antifungaldrugs.