[Pathogenic analysis of ventilator-associated pneumonia in the pediatric intensive care unit in high-altitude areas].

OBJECTIVE: To investigate the pathogens of ventilator-associated pneumonia (VAP) and their drug resistance in the pediatric intensive care unit (PICU) in high-altitude areas and to provide a clinical basis for the prevention and treatment of VAP.

METHODS: A total of 94 children with VAP hospitalized in the PICU in high-altitude areas between June 2011 and June 2013 were recruited. Their lower respiratory tract secretions were collected for bacterial culture and drug sensitivity test.

RESULTS: Of the 94 children with VAP, 22 (23%) had a single bacterial infection, and 72 (77%) had mixed infections, mostly with Klebsiella pneumoniae and Acinetobacter baumannii (17 cases, 27%). Of the 178 isolated strains of pathogens, 139 (78%) were Gram-negative bacteria (G⁻ bacteria), mainly including Klebsiella pneumoniae, Stenotrophomonas maltophilia, Acinetobacter baumannii, and Pseudomonas aeruginosa, 26 (15%) were Gram-positive bacteria (G⁺ bacteria), mainly including Staphylococcus aureus, and 13 (7%) were fungi, mainly including Candida albicans. Most G⁻ bacteria had a high drug resistance. Pseudomonas aeruginosa was extensively drug-resistant. Acinetobacter baumannii was only highly sensitive to cefoperazone/sulbactam and imipenem. Multidrug resistance (methicillin resistance) was found in G⁺ bacteria, for which vancomycin was effective.

CONCLUSIONS: The pathogens of VAP in high-altitude areas are mostly G- bacteria, which may cause mixed infections and develop drug resistance. This provides guidance for the rational use of antimicrobial drugs and the development of key prevention and control measures for VAP.