Abstract 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 Gramnegative 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.
[1]Masterton RG, Galloway A, French G,Street M, Armstrong J, Brown E, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy[J]. J Antimicrob Chemother, 2008, 62(1): 5-34.
[2]American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
[3]Ramirez P, Ferrer M, Torres A. Prevention measures for ventilator-associated pneumonia: a new focus on the endotracheal tube[J]. Curr Opin Infect Dis, 2007, 20 (2): 190-197.
[7]Safdar N, Dezfulian C, Collard HR, Saint S.Clinical and economic consequences of ventilator-associated pneumonia: a systematic review[J]. Crit Care Med, 2005, 33(10): 2184-2193.
[8]Deng C, Li X, Zou Y, Wang J, Wang J, Namba F, et al. Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China[J]. Pediatr Int, 2011, 53(3): 332-337.
[4]Kasuya Y, Hargett JL, Lenhardt R,Heine MF, Doufas AG, Remmel KS,et al.Ventilator-associated pneumonia in critically ill stroke patients: frequency, risk factors, and outcomes[J]. J Crit Care, 2011, 26(3): 273279.
[10]Foglia E, Meier MD, Elward A.Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients[J]. Clin Microbiol Rev, 2007, 20(3): 409-425.
[7]Safdar N, Dezfulian C, Collard HR, Saint S.Clinical and economic consequences of ventilator-associated pneumonia: a systematic review[J]. Crit Care Med, 2005, 33(10): 2184-2193.
[8]Deng C, Li X, Zou Y, Wang J, Wang J, Namba F, et al. Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China[J]. Pediatr Int, 2011, 53(3): 332-337.
[10]Foglia E, Meier MD, Elward A.Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients[J]. Clin Microbiol Rev, 2007, 20(3): 409-425.
[11]Langer M, Mosconi P, Cigada M, Mandelli M. Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control[J]. Am Rev Respir Dis, 1989, 140(2): 302-305.
[12]Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology[J]. J Cardiothorac Vasc Anesth, 2003, 17(1): 22-28.
[13]Chawla R.Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries[J]. Am J Infect Control, 2008, 36(4 Suppl): S93-S100.
[11]Langer M, Mosconi P, Cigada M, Mandelli M. Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control[J]. Am Rev Respir Dis, 1989, 140(2): 302-305.
[14]Garland JS.Strategies to prevent ventilator-associated pneumonia in neonates[J]. Clin Perinatol, 2010, 37(3): 629-643.
[12]Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology[J]. J Cardiothorac Vasc Anesth, 2003, 17(1): 22-28.
[13]Chawla R.Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries[J]. Am J Infect Control, 2008, 36(4 Suppl): S93-S100.