NICU新生儿机械通气细菌培养结果分析及对策

Analysis of result of bacterial culture for neonates with mechanical ventilation in NICU and countermeasures

目的探讨基层新生儿重症监护病房(NICU)机械通气下呼吸道及血液标本细菌培养阳性分布与预后的相关性及对策,以降低基层NICU机械通气下医院感染发生率及提高感染发生后的救治成功率。方法对非感染性疾病入院的机械通气的新生儿实行主动监测,所有患儿送气管导管末端培养,根据临床表现送痰培养或血培养。结果对156例机械通气的新生儿进行主动监测,有99例新生儿培养阳性,阳性率为63.5%;血培养与呼吸道培养为同一细菌的有27例,占27.3%,其中单一血培养阳性11例,占11.1%,单一呼吸道阳性的61例,占61.6%;血及呼吸道培养为同一细菌的病例与单一痰培养阳性、单一血培养阳性及二者培养均阴性的病例相比,病死率要高、平均胎龄低、平均插管时间长,差异有统计学意义(P<0.01);且血及呼吸道培养同一细菌阳性的病例中又以铜绿假单胞菌和大肠埃希菌预后最差。结论基层NICU机械通气管理要进一步规范,低胎龄儿、低体重儿更是是监控的重点对象,抗菌药物使用要更加合理。

OBJECTIVE To investigate the correlation between the distribution of respiratory tract or blood speci-mens with positive bacterial culture and prognosis and put forward the countermeasures so as to reduce the inci-dence of nosocomial infections under the mechanical ventilation in NICU and improve the cure rate. METHODSThe active surveillance was carried out for the mechanical ventilation neonates who were enrolled in the hospitalwith non-infectious diseases,the end of the endotracheal tubes of all the subjects were submitted for the bacterialculture,and the sputum culture or the blood culture was performed based on the clinical manifestations. RESULTSOf totally 156 mechanical ventilation neonates who underwent the active surveillance, 99 neonates were culturedpositive with the positive rate of 63. 5% ; there were 27 （27. 3%） cases with the same species of bacteria culturedfrom the blood and sputum,including 11 （11. 1%） cases with single blood cultured positive and 61 （61. 6%） caseswith single respiratory tract cultured positive. As compared the blood and respiratory culture for the same speciesof bacteria cases with a single positive sputum culture or a single positive blood culture with the both negative cul-tures cases, the former had higher fatality rate, lower mean gestational age,or longer average length of intubationtime, the difference was significant （P〈0. 01） ; of the cases with the same species of bacteria cultured from bloodand respiratory tract,the cases cultured with Pseudomonas aeruginosa and Escherichia coli had the worst prognosis. CONCLUSION The mechanical ventilation should be further standardized in the primary NICUs, the neonateswith low gestational age or low birth weight are the key population of monitoring, and the use of antibiotics shouldbe more reasonable.