新生儿呼吸机相关性肺炎危险因素及病原菌变迁的分析

Risk factors for ventilator-associated pneumonia in neonates and the changes of isolated pathogens

摘要:

目的：探讨新生儿呼吸机相关性肺炎（VAP）的危险因素及病原菌的变迁。方法：选取 2008 年入院新生儿病房机械通气时间≥48 h 的230例新生儿的临床资料进行回顾性分析，并与 8 年前进行比较。结果：2008年VAP发生比率为25.2%，低于8年前的36.1%（P＜0.05）。VAP的发生与胎龄、出生体重呈负相关，与机械通气（MV）时间、住院时间、气管插管次数、胃出血及使用血制品呈正相关（P＜0.05）。病原菌主要是耐药性条件致病菌，以革兰阴性细菌为主（77%），排前 3 位分别是肺炎克雷伯杆菌（20%），嗜麦芽窄食单胞菌（18%），鲍曼不动杆菌（13%）；革兰阳性细菌占23%，以缓症链球菌（14%）为主。而8年前病原菌革兰阴性细菌排前3位分别是克雷伯杆菌属（23%），铜绿假单胞菌（17%），不动杆菌属（16%）；革兰阳性细菌占22%，以缓症链球菌（11%）为主；白色念珠菌（1%）。结论：VAP的发生与胎龄、出生体重、MV时间、住院时间、气管插管次数、是否有胃出血及是否使用血制品密切相关；致病菌主要是耐药性条件致病菌；与 8 年前比较，嗜麦芽窄食单胞菌感染率增加，而铜绿假单胞菌感染率减少。［中国当代儿科杂志，2010，12(12)：936-939］

Abstract:

OBJECTIVE: To study the risk factors for neonatal ventilator-associated pneumonia (VAP) and the changes of isolated pathogens in the last eight years. METHODS: The clinical data of 230 neonates who were admitted into the neonatal intensive care unit (NICU) and received mechanical ventilation for equal to or longer than 48 hrs in 2008 were retrospectively reviewed. The isolated pathogens were compared with those of eight years ago. RESULTS: The incidence of VAP (25.2%) in the year 2008 was lower than that of eight years ago (36.1%; P<0.05). The development of VAP was negatively correlated with the gestational age and the birth weight, but positively correlated with the duration of mechanical ventilation, intubation times, duration of hospitalization, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens were opportunistic antibiotics resistant bacteria, and the majority was gram negative bacilli (77%). The most frequently detected gram negative bacilli were Klebsiella (20%), Stenotrophomonas maltophilia (18%) and Acinetobacter (13%). Streptococcus mitis was the most frequently detected gram positive bacilli (14%). The distribution pattern of pathogens isolated in the same NICU eight years ago was somewhat different: Klebsiella (23%), Pseudomonas aeruginosa (17%), Acinetobacter (16%), Streptococcus mitis (11%), Fungi (1%) and Candida albicans (1%). CONCLUSIONS: The incidence of VAP is correlated with gestational age, birth weight, duration of mechanical ventilation and hospitalization, intubation times, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens are usually antibiotic resistant opportunistic bacteria. The detection rate of Stenotrophomonas maltophilia increased and that of Pseudomonas aeruginosa decreased when compared with eight years ago.［Chin J Contemp Pediatr, 2010, 12 (12):936-939］