Analysis Of Clinical Risk Factors And Pathogens In Neonatal Ventilator-associated Pneumonia

Objective: To investigate the clinical risk factors and pathogeniccharacteristics in neonatal ventilator-associated pneumonia (VAP) by aretrospective analysis of the clinical data and then in order to reduce theincidence and mortality of VAP and improve the success rate of rescue.Methods： Retrospectively analyze the clinical data of135cases ofneonates who had mechanical ventilation for more than48hours in theneonatal intensive care unit (NICU) of Yancheng Maternal and Child HealthCare Hospital and Affiliated Children’s Hospital of Soochow University fromJanuary2012to October2013. The study population was divided into the twogroups according to the diagnosis of VAP,65VAP and70controls．SPSS18.0software package was used to perform statistical analysis. Todo a correlation analysis of related factors such as the duration of mechanicalventilation, gestational age, birth weight, sex, underlying diseases, whiteblood cell count, serum immunoglobulin levels, oxygenation index, trachealintubation times and endotracheal suction times. To analyze the pathogenicbacteria distribution and drug resistance characteristic.Results：Our data showed:(1) According to VAP diagnostic criteria, there were65cases with VAP in the135patients, the incidence of neonatal VAP was48.15%,13cases ofdeath, the mortality rate was20%.(2)Single factor correlation analysis showed: The occurrence of VAP inchildren has close relationship with the factors included mechanicalventilation duration, birth weight, gestational age, oxygenation index, trachealintubation times and endotracheal suction times， there was significantcorrelation between them (P<0.05). There was little effect between theoccurrence of VAP and the factors included sex, underlying diseases, whiteblood cell count and plasma globulin levels, compared with the control group,there was no significant differences between the two groups ofchildren(P>0.05).(3)Multivariate logistic regression analysis showed: The duration ofmechanical ventilation and endotracheal suction times were positivelycorrelated with neonatal VAP (OR1=1.021， CI1=1.005～1.037；OR2=1.42.327，CI2=11.896～150.600；P<0.01). Oxygenation index wasnegatively correlated with VAP(OR=0.216，CI=0.064～0.731，P<0.05).(4)The results of pathogenic detection showed:48strains of bacteriumwere found from the total65patients with VAP, from which37strains(77.08%)were Gram-negative bacill(GNB),11strains(22.92%) wereGram-positive cocci(GPC). The main pathogens were Gram-negativebacteria． Klebsiella pneumonia and Bawmanii were the most common bacteria．They were highly tolerant to many antibiotics，but sensitive toTienam and Mepem．Conclusions：(1)VAP has a high morbidity and mortality.(2)The occurrence of neonatal VAP was affected by many factors, such asmechanical ventilation duration, birth weight, gestational age, oxygenationindex, endotracheal suction times, tracheal intubation times and so on.Comprehensive preventive measures should be adopted to prevent theoccurrence of VAP.(3)VAP pathogens is dominated by Gram-negative bacteria withmulti-drug resistant. Therefore, rational use of antibiotics based onsusceptibility situation is very important for the treatment of VAP.