Pathogenesis and drug resistance of patients with ventilator associated pneumonia in children / 中国基层医药

ABSTRACT

Objective To probe the pathogenesis of ventilator associated pneumonia (VAP) and their resistance to antibiotics of children in pediatric intensive care unit (PICU). Methods A clinical trial in 308 VAP episodes of 134 patients in PICU receiving mechanical ventilation was made. The pathogens and their drug resistance were analyzed. Results A total of 498 pathogen strains were isolated by bacterial culture. The major pathogenic bacteria in VAP were the gram-negative bacilli accounting for 416 strains (83.5%); the gram-positive bacteria were 66 strains (13.2%), staphylococcus aureus 35 strains (7.0%); methicillin-resitant staphylococcus aureus 22 strains (4.4%); staphylococcus epidermidis 19 strains (3.8%); methicillin-resitant staphylococcus epidermidis 11 strains (2.2%); all staphylococcus were sensitive to vancomycin; the fungi were 16 strains (3.2%). Among pathogens, the most common pathogens associated with VAP were klebsiella pneumoniae 155 strains (31.1%), aci netobacter baumanii 56 strains (11.2%), pseudomonas aeruginosa 54 strain (10.8%), escherichia coli 39 strains (7.8%) and staphylococcus aureus 35 strains (7.0%). Their multiple drug-resistance to antibiotics was serious. Drug sensitivity tests indicated that the gram-negative bacilli had lower drug-resistance to such antibiotics as imipenem, amikacin, piperacillin/tazobactam, ceftazidime, cefepime, cefoperazone/sulbactam, ciprofloxacin and amoxycillin/clavulanate. Drug sensitivity tests indicated that the gram-positive bacilli bad lower drug-resistance to such antibiotics as vancomycin, cefazolin, rifampicin, cefaperazone/sulbactam and bad higher drug-resistance to penicillin G and amoxycillin/clavulanate. Polymicrobial pathogens were more isolated in late-onset VAP than those in early-onset VAP. Conclusions The major pathogens in VAP are gram-negative bacilli and there are often multiple drug-resistant and fungus infection was common. It was suggested that the adequate initial empiric antimicrobial treatment should base on the surveillance of etiology and resistance.