Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: Characteristics, risk factors, and outcomes
Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: Characteristics, risk factors, and outcomes
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DOI：
10.1542/peds.112.6.1283
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发表时间：
2003-12-01
期刊：
影响因子：
8
通讯作者：
Fraser, VJ
中科院分区：
文献类型：
--
作者：
Apisarnthanarak, A;Holzmann-Pazgal, G;Fraser, VJ
客观的。旨在确定新生儿重症监护室 (NICU) 极早产儿呼吸机相关性肺炎 (VAP) 的发生率、特征、危险因素和结果。方法。圣路易斯儿童医院对2000年10月至2001年7月期间出生体重<2000克且入住NICU时间>48小时的所有患者进行了一项前瞻性队列研究。极早产新生儿的定义是估计孕龄（EGA）<28周的新生儿。主要结果是 VAP 的发展。次要结局是死亡和 NICU 住院时间 (LOS)。进行多重逻辑回归以确定 VAP 和死亡率的独立预测因子。结果。共有 229 名患者入组。六十七 (29%) 的 EGA < 28 周。 67 名机械通气患者中，有 19 名（28.3%）发生了 19 次 VAP。对于 EGA < 28 周的患者，VAP 率为每 1000 个呼吸机日 6.5 例；对于 EGA > 28 周的患者，VAP 率为每 1000 个呼吸机日 4 例。通过多变量分析，调整气管插管持续时间后，VAP 前的血流感染（调整后的优势比：3.5；95% 置信区间 [CI]：1.2 - 10.8）是 VAP 的独立危险因素。呼吸机相关性肺炎（调整后的比值比：3.4；95% CI：1.2-12.3）是死亡率的独立预测因素。在 NICU 停留超过 30 天的新生儿中观察到 VAP 与死亡率之间存在很强的相关性（相对风险：8.0；95% CI：1.9 - 35.0）。 VAP 患者的 NICU LOS 也延长（中位时间：138 天 vs 82 天）。结论。 VAP 在极早产儿中发生率很高，并且与死亡率增加相关。需要进行更多研究来制定干预措施来预防 NICU 患者的 VAP。
Objective. To determine the rates, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in extremely preterm neonates in a neonatal intensive care unit (NICU).Methods. A prospective cohort study was conducted at the St Louis Children's Hospital on all patients who had birth weight < 2000 g and were admitted to the NICU for > 48 hours from October 2000 to July 2001. Extremely preterm neonates were defined as neonates with estimated gestational age (EGA) < 28 weeks. The primary outcome was the development of VAP. Secondary outcomes were death and NICU length of stay (LOS). Multiple logistic regression was performed to determine independent predictors for VAP and mortality.Results. A total of 229 patients were enrolled. Sixty-seven (29%) had EGA < 28 weeks. Nineteen episodes of VAP occurred in 19 ( 28.3%) of 67 mechanically ventilated patients. VAP rates were 6.5 per 1000 ventilator days for patients with EGA < 28 weeks and 4 per 1000 ventilator days for EGA > 28 weeks. By multivariate analysis, bloodstream infection before VAP ( adjusted odds ratio: 3.5; 95% confidence interval [CI]: 1.2 - 10.8) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation. Ventilator-associated pneumonia ( adjusted odds ratio: 3.4; 95% CI: 1.2 12.3) was an independent predictor of mortality. A strong association between VAP and mortality was observed in neonates who stayed in the NICU > 30 days ( relative risk: 8.0; 95% CI: 1.9 - 35.0). Patients with VAP also had prolonged NICU LOS ( median: 138 vs 82 days).Conclusions. VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality. Additional studies are needed to develop interventions to prevent VAP in NICU patients.