Influencing factors of ventilator-associated pneumonia in neonates with the treament of mechanical ventilation

doi:10.3877/cma.j.issn.1673-5250.2022.02.016

Objective

To explore influencing factors of neonatal ventilator-associated pneumonia (VAP) in neonates with the treatment of mechanical ventilation (MV).

Methods

A total of 68 cases of neonates with treatment of MV who were hospitalized in neonatal intensive care unit (NICU) of Affiliated Hospital of Xuzhou Medical University from June 2018 to May 2021 were selected as research subjects. According to whether neonates developed VAP or not within 48 h after MV treatment, they were included into study group (n=15) and control group (n=53) by retrospective analysis mothod. Gender, gestational age at birth, age, birth weight, mode of delivery, whether it was premature, whether there was primary lung disease, Apgar score, MV duration, reflux of gastric contents, malnutrition, and serum albumin, interleukin (IL)-6, -8 levels were analyzed between two groups by independent-samples t test and chi-square test. Influencing factors of VAP in neonates with MV were analyzed by multivariate unconditional logistic regression analysis method. There were no significant differences in general clinical data as gender composition ratio, age and birth weight of neonates between two groups (P>0.05). This study was approved by Medical Ethics Committee of case collection hospital (Approval No. KY2021010).

Results

①Incidence of VAP in MV neonates was 22.1% (15/68). Among 16 pathogenic strains, which collected from samples of bronchial secretions of 15 neonates with VAP in study group, 14 strains (87.50%) were Gram-negative bacteria, of which Klebsiella pneumoniae and Escherichia coli accounted for a high proportion of 50.00% (8/16) and 18.75% (3/16), respectively. ②Duration of MV, proportion of combined with primary lung disease, gastric contents reflux, malnutrition, and enteral nutrition in study group were significantly higher than those of control group, while gestational age at birth and Apgar score were significantly lower than those of control group, and all differences were statistically significant (P<0.05). ③Multivariate unconditional logistic regression analysis showed those of combined with primary lung disease, low Apgar score, long duration of MV, and reflux of gastric contents were all independent risk factors for VAP in neonates with MV (OR=2.866, 3.096, 2.735, 3.347; 95%CI: 1.326-5.187, 2.053-6.752, 1.035-4.068, 2.438-7.186, P=0.013, 0.006, 0.024, <0.001).

Conclusions

The incidence of VAP in MV neonates is high, and main pathogenic bacteria are Gram-negative bacteria. Among primary lung disease, low Apgar score, long duration of MV, and reflux of gastric contents are all independent risk factors for VAP in neonates with MV, and clinicians should pay attention to these risk factors.

Key words: Pneumonia, ventilator-associated, Ventilators, mechanical, Blood-borne pathogens, Pathogen distribution, Gram-negative bacteria, Risk factors, Infants, newborns

表1 研究组15例VAP新生儿支气管分泌物培养出的16株病原菌占比[株数(%)]

病原菌		构成比
革兰阴性菌		14(87.50)
	肺炎克雷伯杆菌	8(50.00)
	大肠埃希菌	3(18.75)
	产气肠杆菌	2(12.50)
	阴沟肠杆菌	1(6.25)
革兰阳性菌		2(12.50)
	溶血葡萄球菌	1(6.25)
	金黄色葡萄球菌	1(6.25)
合计		16(100.00)

表1 研究组15例VAP新生儿支气管分泌物培养出的16株病原菌占比[株数(%)]

病原菌		构成比
革兰阴性菌		14(87.50)
	肺炎克雷伯杆菌	8(50.00)
	大肠埃希菌	3(18.75)
	产气肠杆菌	2(12.50)
	阴沟肠杆菌	1(6.25)
革兰阳性菌		2(12.50)
	溶血葡萄球菌	1(6.25)
	金黄色葡萄球菌	1(6.25)
合计		16(100.00)

表2 2组MV新生儿相关临床资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	日龄(d，±s)	出生体重(kg，±s)	分娩方式[例数(%)]		早产[例数(%)]
组别	例数	男	女	出生胎龄(周，±s)	日龄(d，±s)	出生体重(kg，±s)	顺产	剖宫产	早产[例数(%)]
研究组	15	9(60.0)	6(40.0)	34.8±2.3	13.5±3.7	2.8±0.7	7(46.7)	8(53.3)	9(60.0)
对照组	53	28(52.8)	25(47.2)	36.2±2.1	15.1±4.1	3.3±1.0	24(45.3)	29(54.7)	23(43.4)
检验值		χ²＝0.242		t＝2.182	t＝1.306	t＝1.645	χ²＝0.009		χ²＝1.294
P值		0.623		0.033	0.196	0.105	0.924		0.255
组别	例数	原发性肺疾病[例数(%)]	Apgar评分(分，±s)	MV治疗时间(d，±s)	胃内容物反流[例数(%)]	营养不良[例数(%)]	插管次数(次，±s)	吸痰次数(次，±s)	置管时间(d，±s)
研究组	15	11(73.3)	6.0±1.3	9.2±3.7	10(66.7)	9(60.0)	2.0±0.7	5.4±1.3	3.1±0.9
对照组	53	22(41.5)	8.3±1.7	5.2±3.1	16(30.2)	17(32.1)	1.8±0.5	4.7±1.0	2.8±0.8
检验值		χ²＝4.740	t＝4.575	t＝4.251	χ²＝6.587	χ²＝3.851	t＝1.170	t＝1.917	t＝1.333
P值		0.029	<0.001	<0.001	0.010	0.048	0.246	0.060	0.187
组别	例数	营养支持[例数(%)]		早期应用抗菌药物[例数(%)]	血清白蛋白(g/L，±s)	血清IL-6(ng/L，±s)	血清IL-8(ng/L，±s)
组别	例数	肠内	肠外	早期应用抗菌药物[例数(%)]	血清白蛋白(g/L，±s)	血清IL-6(ng/L，±s)	血清IL-8(ng/L，±s)
研究组	15	8(53.3)	7(46.7)	6(40.0)	28.3±6.7	182.7±53.2	96.3±27.3
对照组	53	13(24.5)	40(75.5)	33(62.3)	30.2±7.3	168.7±42.4	90.4±24.7
检验值		χ²＝4.545		χ²＝2.369	t＝0.881	t＝1.069	t＝0.800
P值		0.033		0.124	0.382	0.289	0.427

表2 2组MV新生儿相关临床资料比较

组别	例数	性别[例数(%)]		出生胎龄(周，±s)	日龄(d，±s)	出生体重(kg，±s)	分娩方式[例数(%)]		早产[例数(%)]
组别	例数	男	女	出生胎龄(周，±s)	日龄(d，±s)	出生体重(kg，±s)	顺产	剖宫产	早产[例数(%)]
研究组	15	9(60.0)	6(40.0)	34.8±2.3	13.5±3.7	2.8±0.7	7(46.7)	8(53.3)	9(60.0)
对照组	53	28(52.8)	25(47.2)	36.2±2.1	15.1±4.1	3.3±1.0	24(45.3)	29(54.7)	23(43.4)
检验值		χ²＝0.242		t＝2.182	t＝1.306	t＝1.645	χ²＝0.009		χ²＝1.294
P值		0.623		0.033	0.196	0.105	0.924		0.255
组别	例数	原发性肺疾病[例数(%)]	Apgar评分(分，±s)	MV治疗时间(d，±s)	胃内容物反流[例数(%)]	营养不良[例数(%)]	插管次数(次，±s)	吸痰次数(次，±s)	置管时间(d，±s)
研究组	15	11(73.3)	6.0±1.3	9.2±3.7	10(66.7)	9(60.0)	2.0±0.7	5.4±1.3	3.1±0.9
对照组	53	22(41.5)	8.3±1.7	5.2±3.1	16(30.2)	17(32.1)	1.8±0.5	4.7±1.0	2.8±0.8
检验值		χ²＝4.740	t＝4.575	t＝4.251	χ²＝6.587	χ²＝3.851	t＝1.170	t＝1.917	t＝1.333
P值		0.029	<0.001	<0.001	0.010	0.048	0.246	0.060	0.187
组别	例数	营养支持[例数(%)]		早期应用抗菌药物[例数(%)]	血清白蛋白(g/L，±s)	血清IL-6(ng/L，±s)	血清IL-8(ng/L，±s)
组别	例数	肠内	肠外	早期应用抗菌药物[例数(%)]	血清白蛋白(g/L，±s)	血清IL-6(ng/L，±s)	血清IL-8(ng/L，±s)
研究组	15	8(53.3)	7(46.7)	6(40.0)	28.3±6.7	182.7±53.2	96.3±27.3
对照组	53	13(24.5)	40(75.5)	33(62.3)	30.2±7.3	168.7±42.4	90.4±24.7
检验值		χ²＝4.545		χ²＝2.369	t＝0.881	t＝1.069	t＝0.800
P值		0.033		0.124	0.382	0.289	0.427

表3 影响MV新生儿发生VAP的多因素非条件logistic回归分析结果

相关因素	B	SE	Wald值	P值	OR值	OR值95%CI
合并原发性肺疾病(以未合并原发性肺疾病为对照)	1.053	0.416	6.407	0.013	2.866	1.326~5.187
Apgar评分	1.130	0.372	9.227	0.006	3.096	2.053~6.752
MV治疗时间	1.006	0.428	5.525	0.024	2.735	1.035~4.068
胃内容物反流(以未发生胃内容物反流为对照)	1.208	0.351	11.845	<0.001	3.347	2.438~7.186
营养不良(以营养正常为对照)	0.386	0.536	0.519	0.473	1.471	0.156~3.873
肠内营养(以肠外营养为对照)	0.675	0.502	1.808	0.275	1.964	0.462~5.084
出生胎龄	0.642	0.517	1.542	0.238	1.900	0.214~4.738
常数项	1.067	0.538	3.933	0.142	2.907	—

表3 影响MV新生儿发生VAP的多因素非条件logistic回归分析结果

相关因素	B	SE	Wald值	P值	OR值	OR值95%CI
合并原发性肺疾病(以未合并原发性肺疾病为对照)	1.053	0.416	6.407	0.013	2.866	1.326~5.187
Apgar评分	1.130	0.372	9.227	0.006	3.096	2.053~6.752
MV治疗时间	1.006	0.428	5.525	0.024	2.735	1.035~4.068
胃内容物反流(以未发生胃内容物反流为对照)	1.208	0.351	11.845	<0.001	3.347	2.438~7.186
营养不良(以营养正常为对照)	0.386	0.536	0.519	0.473	1.471	0.156~3.873
肠内营养(以肠外营养为对照)	0.675	0.502	1.808	0.275	1.964	0.462~5.084
出生胎龄	0.642	0.517	1.542	0.238	1.900	0.214~4.738
常数项	1.067	0.538	3.933	0.142	2.907	—

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