ĐẶC ĐIỂM VIÊM PHỔI LIÊN QUAN ĐẾN THỞ MÁY Ở TRẺ NON THÁNG TẠI KHOA HỒI SỨC SƠ SINH, BỆNH VIỆN NHI ĐỒNG 2

Abstract

Objective: Preterm infants requiring prolonged mechanical ventilation are at high risk for hospital-acquired pneumonia. This study describes the characteristics, risk factors, causative pathogens, antimicrobial resistance genes, and treatment outcomes of ventilator-associated pneumonia (VAP) in preterm neonates. Methods: A prospective descriptive case series study was conducted on 30 preterm neonates with VAP at the Neonatal Intensive Care Unit, Children’s Hospital 2 (October 2024–June 2025). Endotracheal aspirates were tested using culture and multiplex PCR. Results: The incidence of VAP was 26.4 cases/1,000 ventilator-days; mean gestational age was 30.3 ± 2.3 weeks, mean birth weight 1,418 ± 415 g, and 63.3% were male. Common underlying conditions included respiratory distress syndrome (53.3%) and pre-VAP sepsis (73.3%). Positive culture rate was 80%, mainly Acinetobacter baumannii (43.3%) and Klebsiella pneumoniae (10%). Multiplex PCR positivity was 93.3%, most frequently detecting A. baumannii (63.3%) and K. pneumoniae (26.7%); ≥ 2 microorganisms were co-detected in 46.6%. Frequent resistance genes included OXA51 (56.7%), OXA23 (46.7%), CTX-M1 (43.3%), and KPC (33.3%); KPC and CTX-M1 + KPC combination were associated with mortality (p < 0.05). The most effective antibiotic was colistin (46.7%). Mortality rate was 46.7%, with septic shock significantly associated with death (p < 0.05). Conclusion: VAP in preterm neonates is mainly caused by multidrug-resistant Gram-negative bacteria harboring carbapenemase/ESBL genes. Multiplex PCR enables rapid detection of pathogens and resistance genes, supporting timely and appropriate antibiotic selection.