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[Etiology and high risk factors of neonatal ventilator-associated pneumonia].

OBJECTIVE
Ventilator-associated pneumonia (VAP) is a common nosocomial infection and is responsible for a very high mortality in neonatal intensive care unit (NICU) patients. This study was designed to investigate the etiology and high risk factors of neonatal VAP.


METHODS
The clinical data of 106 critical neonates who were treated with mechanical ventilator between 2003 and 2005 were studied retrospectively.


RESULTS
Of the 106 neonates, 84 received mechanical ventilation for > or = 48 hrs. Thirty-five (41.7%) out of the 84 patients developed VAP. Univariate analysis showed that gestational age, duration of mechanical ventilation, reintubation, birth weights, primary lung disease and gamma globulin administration were associated with the development of VAP (P < 0.05). Multivariate stepwise logistic regression analysis showed that primary lung disease (OR=3.671, 95% CI=1.0-13.45, P < 0.05), duration of mechanical ventilation (OR=4.945, CI=1.51-16.21, P < 0.01), reintubation (OR=7.721, 95% CI=2.31-25.85, P < 0.01) and high-dose gamma globulin administration (OR=5.520, 95%CI=2.08-16.26, P < 0.01) were predicted factors for the development of VAP. The detection rate of gram negative bacilli (76.9%) was the highest, followed by gram positive coccus (17.9%) in VAP patients.


CONCLUSIONS
Opportunistic drug-resistant bacteria are common pathogens for neonatal VAP. The risk of VAP is multifactorial, including external medical environments and patients' internal agents.