新生儿呼吸机相关性肺炎病原菌特点及防治策略

Pathogen Characteristics and Prevention Strategies of Neonatal Ventilator Associated Pneumonia

目的:了解新生儿呼吸机相关性肺炎(VAP)的病原菌特点,探讨防治策略。方法:分析我院新生儿重症监护病房2011年1月至2013年5月机械通气时间≥48 h的90例患儿临床资料。结果:并发新生儿呼吸机相关性肺炎46例,占51.1%,其中革兰阳性球菌占43.5%,革兰阴性杆菌占52.2%,合并真菌感染4.3%,混合感染4.0%。居前四位的细菌是:肺炎克雷伯菌(32.6%)、溶血葡萄球菌(23.9%)、表皮葡萄球菌(13.0%)、大肠埃希菌(10.9%)。药敏试验显示细菌耐药性高。Logistic多元回归分析显示患儿胎龄、机械通气时间、气管插管次数、日均气管吸引次数、留置胃管、原发疾病是高危因素。结论:新生儿VAP病原复杂,细菌耐药性高,高危因素多,要严格掌握抗生素使用适应证,避免耐药发生,加强综合防治,提高VAP的治愈率。

Objective： To understand the pathogens characteristic of neonatal ventilator associated pneumonia （VAP）, and to discuss control strategy. Methods： Clinical data of ninety cases with mechanical ventilation ≥ 48 hours in the hospital neonatal intensive care unit between January 2011 and May 2013 were analyzed. Results： Forty-six cases had neonatal ventilator associated pneumonia （51.1%）, including gram-positive cocci infection （43.5%）, gram negative bacilli infection （52.2%）, merge fungus infection （4. 3% ） , and mixed infection （4.0%）. The top four bacteria were klebsieUa pneumoniae （32.6%）, Hemolysis staphylococcus （23.9%）, Epidermis staphylococcus （ 13.0% ） and Escherichia coli （ 10.9% ）. Drug sensitive tests showed bacterial drug resistance was high. Logistic multivariate regression analysis showed that gestational age, mechanical ventilation time, the number of endotracheal intubation, average daily number of tracheal, indwelling gastric tube, and primary diseases were high risk factors. Conclusions： The pathogen of VAP is complex with high drug resistance. There are many risk factors. The cure rate of VAP could be improved with strict control of antibiotics indication, avoiding the occurrence of bacteria drug-resistance, and strengthening the comprehensive prevention.