Aetiology And Risk Factors Analysis In Children With Ventilator Associated Pneumonia

Objective Through the retrospective analysis about the clinical data of the children, to investigate the pathogens distribution and the risk factors, providing the theoretical basis on clinical prevention and treatment of the ventilator associated pneumonia(VAP) in children, reducing the incidence of VAP and improving the rate of recovery.Methods Collected the clinical date of 151 cases pediatric patients from January 2011 to December 2012, who underwent mechanical ventilation for more than 48 h in the pediatric intensive care unit(PICU) of Tang Shan Maternal and Child Health Care Hospital. The study population was divided into the two groups according to the diagnostic criteria of VAP, observation group(VAP group) and control group(without VAP group). Retrospectively analyzed the clinical data of 151 pediatric patients, such as sex, age, the duration of mechanical ventilation, hospital stays, underlying diseases,repeated tracheal intubation, tracheal intubation times, whether applying intravenous nutrition, gamma globulin and glucocorticoid, and collected the respiratory secretion, s samples to develop and performed the drug susceptibility testing, to discuss the pathogens distribution and the related factors of VAP.Results 1 The incidence of VAP in children: Among 151 cases of mechanical ventilation children, there were 61 cases of VAP, with the rate of 40.40%. Observation group(VAP group) had 11 cases of death(or giving up treatment), with the mortality rate of 18.03%, and control group(not VAP group) had 2 cases of death(or giving up treatment), the mortality rate was 2.22% 。 2 The pathogenic bacteria distribution and resistance of VAP in children: A total of 73 pathogenic microbial strains were isolated from respiratory secretions, including 59 strains of gram-negative bacteria(80.82%).Among of them, Klebsiella pneumonia, Acinetobacter baumannii and Pseudomonas aeruginosa were the major gram-negative bacteria infection. 8 strains of gram-positive bacteria(10.96%) and 6 strains of fungi(8.22%) were isolated. The different bacteria were cultured simultaneously in 12 patients. Pathogens and drug susceptibility test showed that pathogenic bacteria had general drug resistance for commonly clinical antibiotics, but more sensitive to Imipenem and Piperacillin/tazobactam sodium. 3 The occurrence of VAP in children had little relationship with the factors, containing sex, the application of intravenous nutrition, underlying diseases, there was no significant correlation between the two groups(P >0.05). The incidence of VAP in pediatric patients had close connection with the factors, including age, the duration of mechanical ventilation, repeated tracheal intubation, tracheal intubation times, the application of gamma globulin and glucocorticoid, there was statistical significance between them(P<0.05). And the incidence of VAP could extend the length of stay in hospital(P <0.05). 4Multivariate stepwise logistic regression analysis of VAP in children: The duration of mechanical ventilation, tracheal intubation times, the application of glucocorticoid were positive connection with the VAP of pediatric patients. Logistic regression revealed that they were the independent risk factors in the incidence of VAP. The age and the application of gamma globulin were negative connection with the VAP of pediatric patients. The possibility of the incidence of VAP was less in older children, and the application of gamma globulin was the protectant factor to prevent the incidence of VAP in children.Conclusions 1 The predominant pathogenic bacteria of VAP in PICU were Gramnegative bacteria with general multi-drug resistant. 2 there was little effect between the occurrence of VAP and the factors, including sex, the application of intravenous nutrition and underlying diseases. The duration of mechanical ventilation, tracheal intubation times,the application of glucocorticoid were the independent risk factors for the incidence of VAP. The age and the application of gamma globulin were negative connection with the VAP of pediatric patients. There was more possibility of the incidence of VAP in lesser children, and the application of gamma globulin was the protectant factor to prevent the incidence of VAP in children.