NICU新生儿呼吸机相关性肺炎病原菌特点及相关因素分析

Characteristics of pathogenic bacteria and risk factors of ventilator associated pneumonia in newborns hospitalized in NICU

目的分析新生儿重症监护病房(NICU)新生儿呼吸机相关性肺炎(Ventilator Associated Pneumonia,VAP)的病原菌特点及相关因素,为医院感染预防和控制工作提供参考。方法选取医院2014年12月-2017年3月于NICU治疗的新生儿161例为研究对象,对发生VAP患儿病原菌耐药性及发生VAP相关因素进行分析。结果发生VAP新生儿64例,发生率为39.75%,检出病原菌66株,均为革兰阴性菌,以肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌为主。肺炎克雷伯菌对头孢噻吩、头孢噻肟、头孢唑林等的耐药株数较多,而对阿米卡星、环丙沙星、头孢他啶的耐药株数较少。大肠埃希菌和鲍氏不动杆菌对多种头孢菌素类抗菌药物的耐药株数较多,大肠埃希菌对哌拉西林、环丙沙星的耐药株数较少,鲍氏不动杆菌对阿米卡星、亚胺培南、环丙沙星的耐药株数较少。出生体质量、住院治疗时间、插管次数、机械通气时间、出生1 min后Apgar评分是NICU新生儿发生VAP的相关因素(P<0.05),其中,出生体质量和出生1min后Apgar评分是保护因素。结论 NICU新生儿是VAP的高发群体,其发病风险受到多种因素的影响,其病原菌分布和耐药性具有一定的特征性,临床医生应给予及时地诊断、合理地治疗和有效地干预,从而提高医院感染预防和控制工作的效果。

OBJECTIVE To analyze the characteristics of pathogenic bacteria and risk factors of ventilator associated pneumonia（VAP）in newborns hospitalized in neonatal intensive care unit（NICU）to provide basis for the prevention and control of nosocomial infections.METHODS A total of 161 cases of newborns from Dec.2014 to Mar.2017 hospitalized in NICU were selected as the research subjects.The drug resistance of the pathogenic bacteria and the risk factors of VAP were analyzed.RESULTS Totally 64 cases of newborns were observed with VAP,and the infection rate was 39.75%.Totally 66 strains of pathogenic bacteria were detected,which were all gram-negative bacteria.Klebsiella pneumoniae,Escherichia coli,and Acinetobacter baumannii were the main pathogenic bacteria.The drug resistant rates of K.pneumoniae to cephalothin,cefotaxime and cefazolin were higher,and the drug resistant rates to amikacin,ciprofloxacin and ceftazidime were lower.The drug resistant rates of E.coli and A.baumannii to several kinds of cephalosporin antibiotics were higher.The drug resistant rates of E.coli to piperacillin and ciprofloxacin were lower,and the drug resistant rates of A.baumannii to amikacin,imipenem and ciprofloxacin were lower.The birth weight,hospitalization time,intubation times,mechanical ventilation time,and Apgar score at 1 min after birth were risk factors for VAP of newborns hospitalized in NICU（P〈0.05）.The birth weight and Apgar score at 1 min after birth were protective factors.CONCLUSIONThe newborns hospitalized in NICU are the high-risk group of VAP.The risk is affected by many factors.The distribution and the drug resistance of the pathogenic bacteria have certain characteristics.The clinical doctors should give timely diagnosis,reasonable treatment and effective intervention,so as to improve the prevention and control of nosocomial infections.