早产儿口腔菌群在机械通气不同时间点的定植及影响因素

Colonization and influencing factors of oral microbiota in premature infants at different time points of mechanical ventilation

目的探讨早产儿口腔菌群在机械通气不同时间点的定植及影响因素,为开展具有针对性的干预措施提供依据。方法收集2021年7月—2022年12月某三级甲等妇幼保健院新生儿重症监护病房97例早产儿的临床资料,检测早产儿机械通气治疗0、12、24、48、72 h的口腔菌群,分析口腔菌群定植与机械通气时间的相关性及影响因素。结果共采集早产儿口腔菌群检测标本485份,口腔菌群检测阳性127份,检出率为26.19%。不同时间点口腔菌群检出率与机械通气时间呈正相关(r=0.292,P<0.01);两两比较,0 h分别与24、48、72 h,以及12 h分别与48、72 h口腔菌群检出率比较,差异均有统计学意义(均P<0.05)。97例早产儿中65例存在口腔菌群定植,定植率为67.01%,检出菌株146株,其中革兰阳性菌94株(64.38%),革兰阴性菌52株(35.62%);居前5位的病原菌依次为口腔链球菌、大肠埃希菌、表皮葡萄球菌、肺炎克雷伯菌、溶血葡萄球菌。单因素分析显示,出生胎龄、出生体质量、72 h内开奶和使用抗菌药物与口腔菌群定植有关。logistic回归分析显示,出生体质量≥1500 g(OR=0.102,95%CI:0.017~0.634)、72 h内开奶(OR=0.290,95%CI:0.107~0.783)为口腔菌群定植的独立保护因素(均P<0.05)。结论采用机械通气的早产儿应于治疗24 h内尽快检测口腔菌群,并根据菌群变化开展针对性的干预措施,尽早给予母乳喂养或使用母乳进行口腔护理。若不能获得母乳,可采用捐献人乳或早产儿配方奶于72 h内开奶。

Objective To analyze the colonization and influencing factors of oral microbiota in preterm infants at different time points of mechanical ventilation,and provide a basis for the development of targeted intervention measures.Methods Clinical data of 97 premature infants from the neonatal intensive care unit(NICU)in a tertiary first-class maternal and child health care hospital from July 2021 to December 2022 were selected.Oral microbiota of premature infants 0,12,24,48 and 72 hours after mechanical ventilation were detected.Correlation and the influencing factors between oral microbiota colonization and duration of mechanical ventilation were analyzed.Results A total of 485 specimens from premature infants were collected for oral microbiota detection,out of which 127 specimens(26.19%)were positive.Detection rates of oral microbiota at different time points were positively correlated with duration of mechanical ventilation(r=0.292,P<0.01).Pairwise comparison showed statistically significant differences in the detection rates of oral microbiota between 0 hour and 24,48,72 hours,as well as those between 12 hours and 48,72 hours,respectively(all P<0.05).Among 97 premature infants,65 cases had oral microbiota colo-nization,with a colonization rate of 67.01%;146 strains were detected,including 94 Gram-positive bacterial strains(64.38%)and 52 Gram-negative bacterial strains(35.62%).The top 5 pathogenic bacteria were Streptococcus oralis,Escherichia coli,Staphylococcus epidermidis,Klebsiella pneumoniae,and Staphylococcus hemolyticus.Univariate analysis showed that gestational age at birth,birth weight,lactation within 72 hours,and the use of antimicrobial agents were associated with oral microbiota colonization.Logistic regression analysis showed that birth weight≥1500 g(OR=0.102,95%CI:0.017-0.634)and lactation within 72 hours(OR=0.290,95%CI:0.107-0.783)were independent protective factors for oral microbiota colonization(both P<0.05).Conclusion Oral microbiota of premature infants underwent mechanical ventilation should be detected as soon as possible within 24 hours after treatment,and targeted intervention measures should be carried out based on changes in microbiota.Breastfeeding or oral care with breast milk should be given as soon as possible.If breast milk is inaccessible,donated human milk or premature infant formula milk should be adopted within 72 hours.