早产儿呼吸机相关性肺炎病原菌及危险因素

Pathogens isolated from premature infants with ventilator-associated pneumonia and risk factors

目的分析早产儿呼吸机相关性肺炎(VAP)病原菌分布情况及危险因素。方法选择2017年6月-2019年6月河北北方学院附属第一医院新生儿重症监护病房(NICU)收治的行机械通气>48 h的80例早产儿为研究对象,对呼吸道分泌物进行细菌培养及药敏试验,并收集临床资料,利用单因素及多因素Logistic回归分析早产儿发生VAP的危险因素。结果80例患儿中有38例发生VAP,从VAP患儿的呼吸道分泌物细菌培养阳性34例,阳性率89.47%,共分离出37株病原菌;主要革兰阴性菌对亚胺培南、阿米卡星、环丙沙星敏感,主要革兰阳性菌对万古霉素及替考拉宁敏感;多因素Logistic回归分析结果显示:插管次数≥2次、机械通气时间≥72 h、留置胃管≥48 h是早产儿机械通气发生VAP的独立危险因素(均P<0.05),静脉丙种球蛋白注射是保护因素(P<0.05)。结论早产儿机械通气VAP发生率高,插管次数≥2次、机械通气时间≥72 h、留置胃管≥48 h等是发生VAP的独立危险因素,静脉丙种球蛋白注射是保护因素,应对上述高危因素采取针对性措施,改善患儿预后。

OBJECTIVE To investigate the distribution of pathogens isolated from the premature infants with ventilator-associated pneumonia(VAP)and analyze the risk factors.METHODS A total of 80 premature infants who received mechanical ventilation for more than 48 hours in neonatal intensive care unit(NICU)of the First Affiliated Hospital of Hebei North University from Jun 2017 to Jun 2019 were recruited as the study subjects.The respiratory tract secretions specimens were collected for bacterial culture,the drug susceptibility testing was carried out,the clinical data were collected,and univariate analysis and multivariate logistic regression analysis were performed for risk factors for VAP in the premature infants.RESULTS Of the 80 premature infants,38 had VAP,and 34 infants were positive for bacterial culture of respiratory tract secretions,with the positive rate 89.47%.Totally 37 strains of pathogens were isolated.The main gram-negative bacteria were sensitive to imipenem,amikacin and ciprofloxacin;the main gram-positive bacteria to sensitive to vancomycin and teicoplanin.The result of multivariate logistic regression analysis showed that no less than two times of intubation,mechanical ventilation duration no less than 72 hours and gastric tube indwelling time no less than 48 hours were independent risk factors for the VAP in the premature infants(all P<0.05),intravenous injection of gamma globulin was a protective factor(P<0.05).CONCLUSION The incidence rate of VAP is high among the premature infants undergoing mechanical ventilation.No less than two times of intubation,mechanical ventilation duration no less than 72 hours and gastric tube indwelling time no less than 48 hours are the independent risk factors for VAP,and the intravenous injection of gamma globulin is a protective factor.It is necessary to take targeted measures according to the high risk factors so as to improve prognosis of the infants.