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

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Author:
No author available
Journal Title:
Chinese Journal of Perinatal Medicine
Issue:
8
DOI:
10.3760/cma.j.issn.1007-9408.2012.08.005
Key Word:
肺炎,呼吸机相关性;革兰氏阴性菌;抗药性,细菌;微生物敏感性试验;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.

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