Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China

Background: The aim of the present study was to explore the incidence and risk factors of, and summarize the involved pathogens in, neonates with ventilator-associated pneumonia (VAP) in the authors' neonatal intensive care unit (NICU) to determine the effective strategies for prevention. Methods: A retrospective case-control study including 117 VAP patients and 232 controls was conducted from January 2002 to July 2008. The antibiotics sensitivity spectrum was determined on quantitative microbiological evaluation. Multiple logistic regression and Cox model analysis were performed to determine independent and accumulative risk factors for VAP. Results: Multivariate analysis showed that birthweight, mechanical ventilation (MV), parenteral alimentation, dexamethasone and other respiratory disease were associated with the development of VAP. The cumulative risk for developing VAP increased over the duration of stay in the NICU. The most common isolated bacteria of the pathogen spectrum in VAP were Klebsiella spp. (33/146), Acinetobacter baumannii (26/146), Pseudomonas aeruginosa (18/146) and Staphylococcus aureus(13/146). Meanwhile, we found that previous use of antibiotics before VAP diagnosis was not associated with the onset of VAP. Conclusions: The daily risk for VAP increases with duration of stay in the NICU after ventilation. Drug-resistant bacteria are common pathogens for neonatal VAP in the authors' NICU.