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

YING Yan-Fen; CHEN Shang-Qin; HU Xiao-Ya; WANG Neng-Li; LIU Hua-Lan; HU Shu-Ying; LIN Zhen-Lang

PDF(949 KB)

Chinese Journal of Contemporary Pediatrics ›› 2010, Vol. 12 ›› Issue (12) : 936-939.

CLINICAL RESEARCH

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

YING Yan-Fen, CHEN Shang-Qin, HU Xiao-Ya, WANG Neng-Li, LIU Hua-Lan, HU Shu-Ying, LIN Zhen-Lang

Author information +

History +

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］

Key words

Ventilator-associated pneumonia / Risk factor / Pathogen / Neonate

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

YING Yan-Fen, CHEN Shang-Qin, HU Xiao-Ya, WANG Neng-Li, LIU Hua-Lan, HU Shu-Ying, LIN Zhen-Lang. Risk factors for ventilator-associated pneumonia in neonates and the changes of isolated pathogens[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(12): 936-939

References

［1］Chastre J, Luyt CE, Trouillet JL, Combes A. New diagnostic and prognostic markers of ventilator-associated pneumonia［J］. Curr Opin Crit Care, 2006, 12(15): 446-451.
［2］《中华结核与呼吸杂志》编委会.医院内获得性支气管-肺感染诊断标准［J］.中华结核与呼吸杂志, 1990,13（6）：372.
［3］Gopal Katherason S, Naing L, Jaalam K, Imran Musa K, Nik Mohamad NA, Aiyar S, et al. Ventilator-associated nosocomial pneumonia in intensive care units in Malaysia［J］. J Infect Dev Ctries, 2009, 3(9): 704-710.
［4］Rodrigues PM, Carmo Neto E, Santos LR, Knibel MF. Ventilator-associated pneumonia: epidemiology and impact on the clinical evolution of ICU patients［J］. J Bras Pneumol, 2009, 35(11): 1084-1091.
［5］Minei JP, Nathens AB, West M, Harbrecht BG, Moore EE, Shapiro MB, et al. Inflammation and the Host Response to injury, a Large-Scale Collaborative Project: patient-oriented research core-standard operating procedures for clinical care. II. Guidelines for prevention, diagnosis and treatment of ventilator-associated pneumonia (VAP) in the trauma patient［J］. J Trauma, 2006, 60(5): 1106-1113.
［6］张秀勤.新生儿呼吸机相关性肺炎临床分析与防治［J］.河南预防医学杂志,2009,20（5）:405.
［7］Bigham MT, Amato R, Bondurrant P, Fridriksson J, Krawczeski CD, Raake J, et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution［J］. J Pediatr, 2009, 154(4): 582-587.
［8］朱绪亮,赵玲,杨嘉琛,陈晓,吴星恒.新生儿呼吸机相关性肺炎的病原学和高危因素分析［J］.中国当代儿科杂志,2007,9(6):549-552.
［9］陈华友,徐乃军.早产儿呼吸机相关性肺炎高危因素分析［J］.中国实用儿科杂志,2009,24(7):542-544.
［10］Corwin HL, Gettingar A, Pearl RG, Fink MP, Levy MM, Abraham E. The CRIT study: Anemia and blood transfusion in the critically ill-current clinical practice in the United States［J］. Crit Care Med, 2004, 32(1): 39-52.
［11］Taylor RW, O′Brien J, Trottier SJ, Manganaro L, Cytron M, Lesko MF, et al. Red blood cell transfusions and nosocomial infections in critically ill patients［J］.Crit Care Med, 2006, 34(9): 2302-2308.
［12］Ydy LR, Slhessarenko N, de Aguilar-Nascimento JE. Effect of perioperative allogeneic red blood cell transfusion on the immune-inflammatory response after colorectal cancer resection［J］. World J Surg, 2007, 31(10): 2044-2051.
［13］刘英勋,于帮旭,宋雷,张建国,刘家宁. 去白细胞输血对危重患者医院内感染发生的影响［J］.中华现代内科学杂志,2007,4(3):201-203.
［14］Heininger A, Unertl K.Ventilator-associated pneumonia and multiresistant bacteria［J］. Anasthesiol Intensivmed Notfallmed Schmerzther, 2007, 42(2): 122-129.
［15］李明珠,韩艳. 新生儿超广谱β-内酰胺酶细菌感染及防治效果分析［J］. 新生儿科杂志, 2004, 19（5）: 205.