Sun Yue-Lin, Fu Yue-Qiang, Ma Hong-Tu, Liu Cheng-Jun, Xu Feng
Pediatric Intensive Care Unit, Children's Hospital, Chongqing Medical University, Chongqing 400014, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2015 Nov;17(11):1204-9.
To investigate the distribution and drug sensitivity of pathogens and risk factors for ventilator-associated pneumonia (VAP) in children with congenial heart disease (CAD) after surgery.
According to the occurrence of VAP, 312 children with CAD who received mechanical ventilation after surgery for 48 hours or longer between January 2012 and December 2014 were classified into VAP (n=53) and non-VAP groups (n=259). Sputum samples were collected and cultured for pathogens in children with VAP. The drug sensitivity of pathogens was analyzed. The risk factors for postoperative VAP were identified by multiple logistic regression analysis.
The sputum cultures were positive in 51 out of 53 children with VAP, and a total of 63 positive strains were cultured, including 49 strains of Gram-negative bacteria (78%), 9 strains of Gram-positive bacteria (14%) and 5 strains of funqi (8%). The drug sensitivity test showed that Gram-negative bacteria were resistant to amoxicillin, piperacillin, cefotaxime and ceftazidime, with a resistance rate of above 74%, and demonstrated a sensitivity to amikacin, polymyxin and meropenem (resistance rate of 19%-32%). Single factor analysis showed albumin levels, preoperative use of antibiotics, duration of mechanical ventilation, times of tracheal intubation, duration of anesthesia agent use, duration of acrdiopulmonary bypass, duration of aortic occlusion and use of histamin2-receptor blockade were significantly different between the VAP and non-VAP groups (P<0.05). The multiple logistic regression showed albumin levels (<35 g/L), duration of mechanical ventilation (≥ 7 d), times of tracheal intubation (≥ 3), duration of acrdiopulmonary bypass (≥ 100 minutes) and duation of aortic occlusion (≥ 60 minutes) were independent risk factors for VAP in children with CAD after surgery.
Gram-nagative bacteria are main pathogens for VAP in children with CAD after surgery. The antibiotics should be used based on the distribution of pathogens and drug sensitivity test results of pathogens. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to reduce the morbidity of VAP in children with CAD after surgery.
探讨先天性心脏病（CAD）患儿术后呼吸机相关性肺炎（VAP）的病原菌分布、药敏情况及危险因素。
选取2012年1月至2014年12月期间术后机械通气48小时及以上的312例CAD患儿，根据是否发生VAP分为VAP组（n = 53）和非VAP组（n = 259）。收集VAP患儿的痰液样本进行病原菌培养，并分析病原菌的药敏情况。采用多因素logistic回归分析确定术后VAP的危险因素。
53例VAP患儿中51例痰培养阳性，共培养出63株阳性菌株，其中革兰阴性菌49株（78%）、革兰阳性菌9株（14%）、真菌5株（8%）。药敏试验显示，革兰阴性菌对阿莫西林、哌拉西林、头孢噻肟和头孢他啶耐药，耐药率均高于74%，对阿米卡星、多黏菌素和美罗培南敏感（耐药率为19% - 32%）。单因素分析显示，VAP组与非VAP组在白蛋白水平、术前使用抗生素情况、机械通气时间、气管插管次数、麻醉剂使用时间、体外循环时间、主动脉阻断时间及使用组胺2受体阻滞剂方面差异有统计学意义（P < 0.05）。多因素logistic回归分析显示，白蛋白水平（< 35 g/L）、机械通气时间（≥ 7天）、气管插管次数（≥ 3次）、体外循环时间（≥ 100分钟）和主动脉阻断时间（≥ 60分钟）是CAD患儿术后VAP的独立危险因素。
革兰阴性菌是CAD患儿术后VAP的主要病原菌。应根据病原菌分布及药敏试验结果选用抗生素。针对VAP的相关危险因素采取有效的预防措施，以降低CAD患儿术后VAP的发生率。
