新生儿呼吸机相关性肺炎病原菌变迁及危险因素分析

目的 探讨新生儿呼吸机相关性肺炎(VAP)的病原菌变迁及危险因素。 方法 回顾性分析我院新生儿重症监护病房(NICU)机械通气(MV)时间≥ 48 h的前期组179例(2005年12月至2008年12月)和近期组(2009年1月至2012年1月)331例患儿的临床资料,并比较两组VAP的病原菌和药敏情况。 结果 前期组、近期组VAP的发生率分别为22.35%、20.24%,差异无统计学意义(P>0.05)。VAP的主要致病菌为革兰阴性菌(93.40%),前期组排前5位的分别是肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌及阴沟肠杆菌,而近期组分别是肺炎克雷伯菌、鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌及产气肠杆菌;药敏试验结果显示近年病原菌对临床常用抗生素敏感性普遍下降,尤其碳青霉烯类敏感性下降明显,两组比较差异有统计学意义(P<0.05)。MV持续时间(OR=5.680,95%CI:2.867~11.253)、插管次数(OR=2.219,95%CI:1.037~4.748)、出生体质量(OR=2.127,95%CI:1.067~4.238)、新生儿窒息(OR=2.025,95%CI:1.079~3.799)及住院时间(OR=2.012,95%CI:1.215~3.967)为新生儿VAP的独立危险因素。 结论 新生儿VAP致病菌以革兰阴性菌为主,对临床常用抗生素敏感性普遍下降。MV持续时间、插管次数、出生体质量、新生儿窒息及住院时间长与VAP的发生密切相关。

The Risk Factors of Ventilator-associated Pneumonia in Newborn and the Changes of Isolated Pathogens

Objective To study the risk factors of ventilator-associated pneumonia (VAP) in newborn and the profiles of isolated pathogens. Methods The clinical data of 179 neonates in the previous group (from December 2005 to December 2008) and 331 neonates in the present group (from January 2009 to January 2012) admitted into the neonatal intensive care unit (NICU) and received mechanical ventilation for equal or longer than 48 hours were respectively reviewed and analyzed,and their isolated pathogen profile and drug sensitivity were also compared in two groups. Results The incidence of VAP in the previous group and the present group were 22.35% and 20.24% respectively, no significant difference between two groups (P>0.05) was observed. Gram-negative bacteria was the main pathogens (93.40%), the first 5 common pathogens in the previous group were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Enterobacter aerogenes. However, the first 5 of isolated gram-negative pathogens in the present group were somewhat different from the previous group, which were Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli and Enterobacter aerogenes. The drug sensitivity test showed that these pathogens had a general decline in sensitivities to commonly used antibiotics, of which the carbapenem antibiotic drug sensitivity decreased significantly, there was statistically significant difference between the previous group and the present group (P<0.05). The risk factors of VAP include the duration of mechanical ventilation (OR=5.680, 95%CI:2.867-11.253), the frequency of tracheal intubation (OR=2.219, 95%CI:1.037-4.748), birth weight (OR=2.127, 95%CI:1.067-4.238) and neonatal asphyxia (OR=2.025, 95%CI:1.079-3.799) as well as the duration of hospital stay (OR=2.012, 95%CI:1.215-3.967). Conclusions According to the data in our hospital, the main pathogenic bacteria of VAP were gram-negative pathogens, which showed a general decline in sensitivities to commonly used antibiotics. The incidence of VAP was closely related to the duration of mechanical ventilation, the frequency of intubation, birth weight and the hospitalization as well as the neonatal asphyxia.