机械通气新生儿气管导管的生物膜菌群分析及其与呼吸机相关性肺炎的关系  

Bacterial flora of biofilm in the endotracheal tube of mechanically ventilated neonates and its relationship with ventilator-associated pneumonia

作　　者：雷一慧[1] 林素[1] 潘冰婷 陈尚勤[1] 林振浪[1] 麦菁芸[1] Lei Yihui;Lin Su;Pan Bingting;Chen Shangqin;Lin Zhenlang;Mai Jingyun(Department of Neonatology,The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院新生儿科,温州325027

出　　处：《中华传染病杂志》2022年第11期656-662,共7页Chinese Journal of Infectious Diseases

基　　金：温州市公益性科技计划项目医疗卫生科技项目(Y20170137)。

摘　　要：目的探讨新生儿气管导管内腔表面细菌生物膜(endotracheal tube-bacterial biofilm, ETT-BF)与呼吸机相关性肺炎(ventilator-associated pneumonia, VAP)之间的关系。方法纳入2019年1月至2020年1月在温州医科大学附属第二医院新生儿科采取气管插管留置时间≥48 h的新生儿30例, 根据气管导管留置时间分为A组(2~6 d)13例、B组(7~14 d)9例和C组(>14 d)8例。观察扫描电子显微镜下ETT-BF的形态, 分析3组患儿VAP的发生率, 气管导管表面分离菌株阳性率和下呼吸道分泌物分离菌株阳性率、菌株检出情况及其耐药性。统计学分析采用χ^(2)检验。结果扫描电子显微镜结果提示气管导管留置达3 d可在气管导管内腔表面观察到片状基质物, 留置4 d可见球菌黏附, 随着气管导管留置时间延长, 细菌生物膜结果趋近完善。30例新生儿中, 下呼吸道分泌物分离菌株阳性率达23.3%(7/30), 均为革兰阴性菌。A组无患儿发生VAP, B组有2例VAP患儿, C组有5例VAP患儿, 3组VAP发生率差异有统计学意义(χ^(2)=10.82, P=0.004)。不同气管导管留置时间下气管导管表面分离菌株阳性率差异无统计学意义(χ^(2)=1.03, P=0.598)。13例A组患儿中气管导管表面分离菌株阳性者7例, 主要为革兰阳性菌, 随着留置时间延长, 气管导管表面分离菌株逐渐以革兰阴性菌为主。在7例VAP患儿中, 5例下呼吸道分泌物分离菌株与其对应气管导管表面分离菌株一致, 分别为液化沙雷菌、产酸克雷伯菌、黏质沙雷菌、脑膜脓毒性黄杆菌、嗜麦芽窄食单胞菌, 且菌株耐药性一致。结论早期的ETT-BF定植菌可能来自上呼吸道, 较少发生迁移引起VAP, 随着气管导管留置时间延长, 患儿的VAP发生率升高, 气管导管表面及下呼吸道分泌物可发现同一病原菌, 具体病原菌来源仍有待进一步研究阐明。Objective To explore the relationship between endotracheal tube-bacterial biofilm(ETT-BF)in mechanically ventilated neonates and ventilator-associated pneumonia(VAP).Methods A total of 30 mechanically ventilated neonates whose mechanical ventilation time were≥48 h in the Department of Neonatology in The Second Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were included.According to the indwelling time of endotracheal tube,all cases were divided into three groups including group A(two to six days),group B(seven to 14 days)and group C(over 14 days).The morphological results of ETT-BF were scanned by scanning electron microscope(SEM).The incidence of VAP,the positive rates of strains isolated from endotracheal tube surface and lower respiratory tract secretion,the detection of strains and drug resistance were analyzed.Chi-squared test were used for statistical analysis.Results The results of SEM showed that sheet matrix could be observed on the surface of the inner cavity of endotracheal tube in three days of tracheal catheter retention,and cocci adhered to it in four days.With prolonged indwelling time of endotracheal tube,the structure of bacterial biofilm(BF)had improved.The positive rate of strains isolated from the secretion of lower respiratory tract in 30 neonates was 23.3%(7/30)and all of them were Gram-negative bacteria.There was no patient developed VAP in group A,while there were two patients with VAP in group B,and five patients with VAP in group C.The incidences of VAP in the three groups were statistically significant(χ^(2)=10.82,P=0.004).There was no significant difference in the positive rate of strains isolated from the surface of endotracheal tube under different indwelling time in 30 cases(χ^(2)=1.03,P=0.598).Among of 13 neonates in group A,there were seven strains isolated from ETT-BF,mainly Gram-positive bacteria which turned out to be mainly Gram-negative bacteria with the prolongation of endotracheal tube indwelling time.Of the seven VAP cases,strains

关 键 词：气管导管细菌生物膜 菌群多样性 抗药性 肺炎 呼吸机相关性 新生儿 

分 类 号：R51[医药卫生—内科学] R563.1[医药卫生—临床医学]