新生儿呼吸机相关性肺炎的病原菌分布与耐药性及影响因素分析

Analysis on the distribution, drug resistance and influencing factors of neonatal ventilator-associated pneumonia

目的分析新生儿呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原菌分布、耐药性及影响因素,为医院感染预防和控制工作提供研究依据。方法选取2016年4月-2018年3月在河北北方学院附属第一医院接受机械通气治疗的205例新生儿作为研究对象,采用回顾性分析的方法对纳入新生儿的VAP发生率进行观察,采集感染患儿的痰样本进行病原学检查,对其病原菌分布及耐药性进行分析,收集感染患儿与未感染患儿的临床资料,对其感染影响因素进行分析。结果有92例患儿发生VAP,感染率为44.88%,在71例患儿的下呼吸道分泌物或气管插管终端分泌物中检出病原菌,检出率为77.17%,共检出87株病原菌,其中,革兰阴性菌78株占89.66%,革兰阳性菌7株占8.05%,真菌2株占2.30%;革兰阴性菌对头孢噻肟、阿莫西林、头孢唑林、哌拉西林、阿莫西林/克拉维酸、磺胺甲噁唑/甲氧苄啶的耐药率较高,对阿米卡星、环丙沙星、左氧氟沙星的耐药率较低;检出11株产超广谱β-内酰胺酶(extended-spectrum beta-lactamase,ESBLs)肺炎克雷伯菌和17株产ESBLs大肠埃希菌,检出率37.93%和62.96%;Logistic多元回归分析结果显示,胎龄、出生体质量、机械通气时间、插管次数为新生儿VAP发生的影响因素(P<0.05)。结论新生儿VAP的病原菌以肺炎克雷伯菌、大肠埃希菌等革兰阴性菌为主,均具有较高的耐药性,VAP发生风险与通气治疗因素和患儿发育因素有关,临床医生应根据其病原菌分布特征和影响因素情况合理制订预防和控制方案。

OBJECTIVE To analyze the distribution,drug resistance and influencing factors of neonatal ventilator-associated pneumonia(VAP),so as to provide the basis for the prevention and control of nosocomial infections.METHODS Totally 205 newborns undergoing mechanical ventilation in the hospital from Apr.2016 to Mar.2018 were selected as the research subjects.The incidence of VAP in these newborns was observed by retrospective analysis.Sputum samples were collected from infected children for etiological examinations.The distribution and drug resistance of pathogens were analyzed.The clinical data of the infected and uninfected children were collected and the influencing factors of infection were analyzed.RESULTS Totally 92 cases were with VAP,and the infection rate was 44.88%.In 71 cases,the pathogens were detected in the lower respiratory secretions or the tracheal intubation terminal exudates.The detection rate was 77.17%.A total of 87 strains of pathogens were detected,among them,78 strains were Gram-negative bacteria accounting for 89.66%,7 strains were Gram-positive bacteria accounting for 8.05%,and 2 strains were fungi accounting for 2.30%.The drug resistance rates of Gram-negative bacteria to cefotaxime,amoxicillin,cefazolin,piperacillin,amoxicillin/clavulanic acid and sulfamethoxazole/trimethoprim were relatively high,and the drug resistance rates to amikacin,ciprofloxacin and levofloxacin were relatively low.11 strains of extended-spectrum beta-lactamase(ESBLs)producing Klebsiella pneumoniae and 17 strains of ESBLs producing Escherichia coli were detected,and the detection rates were 37.93%and 62.96%,respectively.The results of Logistic multivariate regression analysis showed that the incidence of VAP in newborns was correlated with gestational age,birth weight,mechanical ventilation time and intubation times(P<0.05).CONCLUSION The pathogens of VAP in newborns are mainly Gram-negative bacteria such as Klebsiella pneumoniae and Escherichia coli,all of which have high drug resistance.The risk of VAP is related to the factors of ventilation treatments and neonatal development.The clinicians should make the prevention and controlling scheme according to the distribution characteristics of the pathogens and the influencing factors.