Distribution and antibiotic sensitivity of pathogens in neonates with ventilator-associated pneumonia

( views:472, downloads:0 )
Author:
ZHOU Qi(Department of Neonatology, Children's Hospital of Fudan University , Shanghai 201102,China)
CAO Yun(Department of Neonatology, Children's Hospital of Fudan University , Shanghai 201102,China)
LEE Shoo K()
CAI Xiao-di(Department of Neonatology, Children's Hospital of Fudan University , Shanghai 201102,China)
CHEN Chao(Department of Neonatology, Children's Hospital of Fudan University , Shanghai 201102,China)
HU Xiao-jing(Department of Neonatology, Children's Hospital of Fudan University , Shanghai 201102,China)
WANG Chuan-qing()
Journal Title:
Chinese Journal of Perinatal Medicine
Issue:
Volume 15, Issue 08, 2012
DOI:
10.3760/cma.j.issn.1007-9408.2012.08.005
Key Word:
Pneumonia, ventilator-associated;Gram-negative bacteria;Drug resistance,bacterial;Microbial sensitivity tests

Abstract: Objective To investigate the distribution of pathogens and antibiotic sensitivity in neonates with ventilator-associated pneumonia (VAP) in a Chinese neonatal intensive care unit (NICU),providing evidence for rational administration of antibiotics and nosocomial infection control.Methods The neonates admitted into NICU of Children's Hospital,Fudan University subjected to tracheal intubation-mechanical ventilation for ≥ 48 h and hospitalized for ≥5 d during three stages were selected in this study.The first stage was from February 1,2006 to January 31,2007; the second stage was from August 1,2008 to July 31,2009 and the third stage was from January 1,2010to December 31,2010.Related clinical and laboratory information of these neonates was collected.Sputum specimens from the lower respiratory tract in VAP newborns were collected for the detection of pathogens.Antimicrobial susceptibility testing was carried out by Kirby-Bauer method according to the unified protocol.Continuous variables were summarized in mean± standard deviation ((x)± s).Categorical variables were summarized using count and percentage.Categorical variables were evaluated using the Chi-square.Continuous variables were evaluated using t-test or one-way ANOVA,as appropriate.Results The incidence of VAP was declined gradually after implement of a bundle of infection-control practices.There were 491 patients enrolled during three stages,and 92 VAP cases among them.The incidence of VAP was 27.3 per 1000 ventilated days.In three stages,there were 38,22 and 32 VAP cases,and the incidence of VAP was 48.8,25.7 and 18.5 per 1000 ventilated days respectively (x2 =26.19,P =0.000).Gram-negative bacilli (63 strains,95.5%) were the primary VAP microorganisms in all stages,and the most common organisms isolated for VAP during three periods were Acinetobacter baumannii (43 strains,65.2%),Klebsiella pneumonia (10 strains,15.2%),Escherichia coli and Pseudomonasaeruginosa (4 strains,6.1% in each).In the first stage,antimicrobial susceptibility test showed that all Acinetobacter baumannii were resistant to Cephalosporin, and antimicrobial susceptibility of Carbapenems was 57.9%.Eight multi-drug resistant bacterial strains were isolated.After implemented the infection-control practices during the second stage,75.0% Acinetobacter baumannii were sensitive to Cephalosporin (x2 =16.39,P =0.000) and no multi-drug resistant or Carbapenem-resistant strains were isolated.However,compared with the second stage,the antimicrobial susceptibility to the third-generation Cephalosporin and Carbapenems in the third stage declined to 5.0 % (x2 =11.76,P =0.001) and 20.0 % (x2 =6.72,P=0.01) respectively.Additionally,10 multi-drug-resistant strains were isolated.Conclusions Gram-negative bacilli were the primary VAP microorganisms in the NICU.Implement of a bundle of infection-control practices might reduce the incidence of VAP in NICU.While,pathogen's species might change year by year.Regular analysis and monitoring of pathogen's species and variance of drug resistance in local patients with VAP might have important significance to guide the clinical use of antimicrobial agents and effective control of the incidence of VAP.

  • [1]蔡小狄,曹云,陈超,等.鲍曼不动杆菌感染的呼吸机相关肺炎20例.微生物与感染,2008,3:27-29,38.
  • [2]Warren DK,Shukla SJ,Olsen MA,et al.Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.Crit Care Med,2003,31:1312-1317.
  • [3]American Thoracic Society,Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia.Am J Respir Crit Care Med,2005,171:388-416.
  • [4]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案).现代实用医学,2002,14:160-161.
  • [5]Mayhall CG.Surveillance of nosocomial infections//Hospital epidemiology and infection control.3rd ed.London:Lippincott Williams &.Wilkins,2004:1659-1702.
  • [6]叶应妩,王毓三.全国临床检验操作规程.3版.南京:东南大学出版社,2006.
  • [7]Clinical and Laboratory Standards Institute (National Committee for Clinical Laboratory Standards).Performance Standards for Antimicrobial Susceptibility Testing:sixteenth informational Supplemant.Wayne:Clinical and Laboratory Standards Institute,2006.
  • [8]Clinical and Laboratory Standards Institute (National Committee for Clinical Laboratory Standards).Performance Standards for Antimicrobial Susceptibility Testing:seventeenth informational Supplemant.Wayne:Clinical and Laboratory Standards Institute,2007.
  • [9]Clinical and Laboratory Standards Institute (National Committee for Clinical Laboratory Standards).Performance Standards for Antimicrobial Susceptibility Testing:eighteenth informational Supplemant.Wayne:Clinical and Laboratory Standards Institute,2008.
  • [10]Clinical and Laboratory Standards Institute (National Committee for Clinical Laboratory Standards).Performance Standards for Antimicrobial Susceptibility Testing:nighteenth informational Supplemant.Wayne:Clinical and Laboratory Standards Institute,2009.
  • [11]Clinical and Laboratory Standards Institute (National Committee for Clinical Laboratory Standards).Performance Standards for Antimicrobial Susceptibility Testing:twentieth informational Supplemant.Wayne:Clinical and Laboratory Standards Institute,2010.
  • [12]Venkatram S,Rachmale S,Kanna B.Study of device use adjusted rates in health care-associated infections after implementation of “ bundles” in a closed-model medical intensive care unit.J Crit Care,2010,25:174,e11-e18.
  • [13]Lachman P,Yuen S.Using care bundles to prevent infection in neonatal and pediatric ICUs.Curr Opin Infect Dis,2009,22:224-228.
  • [14]余加林.新生儿机械通气相关性肺炎.临床儿科杂志,2007,25:166-169.
  • [15]Lankford MG,Zembower TR,Trick WE,et al.Influence of role models and hospital design on hand hygiene of healthcare workers.Emerg Infect Dis,2003,9:217-223.
  • [16]Stover BH,Shulman ST,Bratcher DF,et al.Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units.Am J Infect Control,2001,29:152-157.
  • [17]朱绪亮,赵玲,杨嘉琛,等.新生儿呼吸机相关性肺炎的病原学和高危因素分析.中国当代儿科杂志,2007,9:549-552.
  • [18]王运中,陶云珍,丁云芳,等.新生儿呼吸机相关肺炎病原菌分析.临床儿科杂志,2004,22:717-718.
  • [19]闫钢风,曹云,瞿涤,等.新生儿重症监护病房多重耐药鲍曼不动杆菌β-内酰胺酶的基因型.中华围产医学杂志,2011,14:257-260.
  • [20]Dijkshoorn L,Nemec A,Seifert H.An increasing threat in hospitals:multidrug-resistant Acinetobacter baumannii.Nat Rev Microbiol,2007,5:939-951.
  • [21]Giamarellou H, Antoniadou A, Kanellakopoulou K.Acinetobacter baumannii: a universal threat to public health?.Int J Antimicrob Agents,2008,32:106-119.
  • [22]Niederman MS.De-escalation therapy in ventilator-associated pneumonia.Curr Opin Crit Care,2006,12:452-457.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn