Health Research Institute Hospital La Fe, Valencia, Spain.
Pediatr Crit Care Med. 2013 Jan;14(1):55-61. doi: 10.1097/PCC.0b013e318253ca31.
To establish the incidence, etiology, risk factors, and outcomes associated with ventilator-associated pneumonia using an invasive sampling technique to avoid contamination.
Eligible patients were intubated neonates treated with mechanical ventilation who followed the criteria of the Centers for Disease Control and Prevention/National Nosocomial Infection Surveillance. Bronchoalveolar lavage samples were collected using a blind-protected catheter to avoid contamination of upper respiratory microorganisms. Isolation of >10(3) colony-forming unit/mL was required for diagnosis.
In 198 neonates intubated for >48 hrs, a total of 18 episodes of ventilator-associated pneumonia in 16 infants representing a prevalence of 8.1 were diagnosed. The pooled mean ventilator-associated pneumonia rate was 10.9/1,000 ventilator days. The mean age at diagnosis of ventilator-associated pneumonia was 29 ± 15 days after a mean of 21 ± 16 days of mechanical ventilation. Gram-negative bacteria were the most commonly isolated pathogens and Pseudomonas aeruginosa was the most frequent causative agent. Hospital length of stay was significantly longer for ventilator-associated pneumonia patients; however, no significant differences in mortality were found. Univariate analysis comparing patients with and without ventilator-associated pneumonia showed that days of mechanical ventilation, days of oxygen, number of reintubations, number of transfusions, bloodstream infection, and enteral feeding were all significantly associated with ventilator-associated pneumonia. However, in multivariate analysis the unique independent risk factor was days of mechanical ventilation (odds ratio 1.12, confidence interval 95% 1.07-1.17).
Ventilator-associated pneumonia is a frequent nosocomial infection in newborns. Only duration of mechanical ventilation has been identified as an independent risk factor for ventilator-associated pneumonia. The use of a blind invasive sampling technique seems to diminish sample contamination.
使用侵袭性采样技术避免污染，确定与呼吸机相关性肺炎相关的发病率、病因、危险因素和结果。
符合条件的患者为接受机械通气治疗的插管新生儿，并符合疾病控制与预防中心/全国医院感染监测的标准。使用盲法保护导管采集支气管肺泡灌洗样本，以避免上呼吸道微生物污染。诊断需要分离出>10(3)个菌落形成单位/mL。
在 198 名插管时间超过 48 小时的新生儿中，共诊断出 16 例婴儿的 18 例呼吸机相关性肺炎，患病率为 8.1%。呼吸机相关性肺炎的总发生率为每 1000 个通气日 10.9 例。诊断为呼吸机相关性肺炎的平均年龄为机械通气 21 ± 16 天后的 29 ± 15 天。革兰氏阴性菌是最常见的分离病原体，铜绿假单胞菌是最常见的病原体。呼吸机相关性肺炎患者的住院时间明显延长，但死亡率无显著差异。比较有和无呼吸机相关性肺炎患者的单因素分析表明，机械通气天数、吸氧天数、重新插管次数、输血次数、血流感染和肠内喂养均与呼吸机相关性肺炎显著相关。然而，多因素分析表明，唯一的独立危险因素是机械通气天数（比值比 1.12，95%置信区间 1.07-1.17）。
呼吸机相关性肺炎是新生儿常见的医院获得性感染。只有机械通气时间被确定为呼吸机相关性肺炎的独立危险因素。使用盲法侵袭性采样技术似乎可以减少样本污染。
