Objective: To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China. Method: A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis. Result: A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children's hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%). Conclusion: The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.
目的：调查我国新生儿呼吸机相关肺炎(VAP)的流行病学资料及病原菌分布特点。 方法：分析2015年5月至2016年4月全国25家医院三级新生儿重症监护室(NICU)收治的出生胎龄<34周所有患儿的临床资料，根据医院性质分组为儿童专科医院和妇婴医院或综合性医院，计算VAP发生率。采用χ(2)检验，t检验或秩和检验进行统计学分析。 结果：共纳入患儿7 918例，其中男4 623例(58.4%)，出生体重为(1 639±415)g，出生胎龄为(31.4±2.0)周，4 654例(58.8%)接受无创通气，2 154例(27.2%)接受有创机械通气。发生VAP 95例，总的VAP发生率为7.0/1 000个呼吸机使用日，各研究单位VAP发生率为(0～34.4)/1 000个呼吸机使用日。根据医院性质分组，7家儿童专科医院与18家妇婴医院或综合性医院VAP发生率差异无统计学意义[(9.6比6.0)/1 000个呼吸机使用日，t＝1.002，P＝0.327]。检出病原菌83株，以革兰阴性杆菌(76株，91.6%)最常见，主要为鲍曼不动杆菌(24株，28.9%)，肺炎克雷伯杆菌(23株，27.7%)及铜绿假单胞菌(10株，12.0%)。 结论：我国NICU平均VAP发生率接近发达国家水平，但不同医院之间差异显著，应加强各NICU医院内感染的定期监测和分析，在此基础上实施有效的感染综合防治措施，降低VAP发生率。.
Keywords: Infant, newborn; Multicenter study; Pathogen; Pneumonia, ventilator-associated.