新生儿呼吸机相关性肺炎病原菌及危险因素分析

目的：分析新生儿呼吸机相关性肺炎（VAP）的病原菌、药敏情况及危险因素。方法：对2008年1月至2012年2月入住新生儿重症监护病房（NICU）机械通气时间≥48 h的401例患儿的临床资料进行回顾性分析，其中85例患儿发生了VAP。结果：革兰阴性菌为VAP的主要致病菌（97%），前3位致病菌依次为肺炎克雷伯菌（51%）、鲍曼不动杆菌（17%）、大肠埃希菌（12%）。药敏试验显示病原菌对临床常用抗菌药物阿莫西林、阿莫西林/克拉维酸、哌拉西林、头孢他啶、头孢唑林、头孢噻肟等均耐药（药敏率<15%），且对亚胺培南、美洛培南的药物敏感性明显下降（药敏率<75%）。出生体重(OR=1.399，P<0.05)、机械通气时间（OR=1.966，P<0.01)、住院时间（OR=1.812，P<0.01)、插管次数（OR=2.056，P<0.01）、1 min Apgar评分（OR=2.146，P<0.01）为新生儿VAP的独立危险因素。结论：新生儿VAP的发生受多种因素的影响，其致病菌以革兰阴性菌为主，临床上应根据药敏试验结果合理使用抗菌药物，同时采取综合防治措施，有效减少VAP的发生。

Pathogens and risk factors for ventilator-associated pneumonia in neonates

Objective To study the pathogens,drug sensitivity and risk factors for ventilator-associated pneumonia(VAP) in neonates.Methods Retrospective analysis was performed on the clinical data of 401 neonates who were admitted to the neonatal intensive care unit and received mechanical ventilation for 48 hours or longer from January 2008 to February 2012.Eighty-five of the 401 neonates suffered VAP.Results The main pathogens for VAP were Gram-negative bacteria(97%),including Klebsiella pneumoniae(51%),Acinetobacter baumannii(17%) and Escherichia coli(12%) as the three most frequent ones.The drug sensitivity test showed that these pathogens developed resistance to amoxicillin,amoxicillin/clavulanic acid,piperacillin,ceftazidime,cefazolin,and cefotaxime,with a susceptibility rate of below 15%,and demonstrated decreased sensitivity to imipenem and meropenem,with a susceptibility rate of below 75%.The independent risk factors for neonatal VAP included birth weight(OR=1.399,P<0.05),duration of mechanical ventilation(OR=1.966,P<0.01),length of hospital stay(OR=1.812,P<0.01),times of tracheal intubation(OR=2.056,P<0.01),and 1 min Apgar score(OR=2.146,P<0.01).Conclusions The incidence of neonatal VAP is influenced by many factors.The main pathogens for neonatal VAP are Gram-negative bacteria and antibacterial agents should be properly used according to drug sensitivity test results.Comprehensive prevention and control measures should be taken to reduce the incidence of VAP.