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Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: A meta-analysis

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Background

Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units. However, limited literature has been reviewed to synthesize the findings about the incidence, case fatality rate, pathogen distribution, and drug resistance of neonatal VAP in China.

Methods

A search of electronic databases was undertaken to identify the incidence, case fatality rate, pathogen distribution, and drug resistance of neonatal VAP based on the inclusion and exclusion criteria. Meta-analysis was carried out using R3.0.2 software.

Results

A total of 16,587 participants were included in our final analysis. The incidence and case fatality rates were 42.8% and 16.4%, respectively. Gram-negative bacteria were detected in 77.6% of cultures, followed by gram-positive bacteria (18.8%) and fungi (3.7%). Gram-negative bacteria were sensitive to meropenem, imipenem, and ciprofloxacin, with resistance rates of 1.5%-25.0%, 4.9%-29.0%, and 8.5%-24.7%, respectively. Gram-positive bacteria have resistance rates as high as 72.7%-99.1% to penicillin, 62.6%-90.9% to erythromycin, and 80.3%-91.9% to oxacillin.

Conclusions

The incidence and case fatality rates of neonatal VAP are high in China. VAP was mainly caused by gram-negative bacteria that were resistant to most common antibiotics. The future study of drug-resistance mechanisms should be intensified, and effective measures of hospital infection control should be considered to prevent the outbreak of drug-resistant strains.

Section snippets

Literature search and screening strategy

All studies related to pathogenic bacteria and drug resistance of neonatal VAP published up to November 16, 2013, with a second search done on February 21, 2014, were identified via systematic search in PubMed, Web of Science, China National Knowledge Infrastructure, Chinese Biological Medical Database, VIP Database for Chinese Technical Periodicals, and Wanfang database using the English and Chinese languages. The following search terms were used: pneumonia, ventilator-associated [mesh],

Study description

A total of 849 potentially relevant publications were systematically identified through literature searches of PubMed, Web of Science, China National Knowledge Infrastructure, Chinese Biological Medical Database, VIP Database for Chinese Technical Periodicals, and Wanfang databases. Among these publications, 585 were excluded because they were just identical studies retrieved through different databases. A total of 94 publications were also excluded via full-text screening because they were not

Discussion

One of the main objectives of clinical research is to obtain clear and reliable results that can be used in patient management and as a basis for clinical guidelines. However, clinical trials do not always reach this target and often give contrasting results. Meta-analysis, if correctly used, can contribute to achieve this target because of its other strengths, such as increasing the statistical power by making comparison between studies by using larger sample sizes.10 Thus, it has been widely

Conclusions

The incidence and case fatality rates of neonatal VAP were high, and the main infectious pathogens were gram-negative bacteria. A high resistance to commonly used antibiotics was observed. As such, controlling hospital infections may be difficult. Therefore, future research on drug-resistance mechanisms should be strengthened and effective measures of hospital infection control should be considered to prevent the outbreak of multidrug-resistant strains.

References (21)

  • F. Jaimes et al.

    Incidence and risk factors for ventilator associated pneumonia in a developing country: where is the difference?

    Respir Med

    (2007)
  • G.U. Meduri

    Diagnosis of ventilator-associated pneumonia

    Infect Dis Clin North Am

    (1993)
  • We can end poverty: millennium development goals and beyond.2015. Available from: http://www.un.org/millenniumgoals/....
  • V.G. Hemming et al.

    Nosocomial infections in a newborn intensive-care unit. Results of forty-one months of surveillance

    N Engl J Med

    (1976)
  • R. Srinivasan et al.

    A prospective study of ventilator-associated pneumonia in children

    Pediatrics

    (2009)
  • M.H. Kollef et al.

    Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial

    JAMA

    (2008)
  • Hospital acquired pneumonia diagnosis and treatment guidelines (Draft)

    Modern Pract Med

    (2002)
  • J.P. Higgins et al.

    Measuring inconsistency in meta-analyses

    BMJ

    (2003)
  • Q.L. Ma

    Study on the division and the coordinated development of regional economic region in China

    South China Finance

    (2009)
  • L. Gioacchino

    Meta-analysis in medical research: the handbook for the understanding and practice of meta-analysis

    (2005)
There are more references available in the full text version of this article.

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This study was supported by grants from the National Natural Science Foundation of China (grant Nos. 31071093, 31170129, and 31200064) and the Natural Science Foundation of Chongqing (grant No. 2010BB5354).

Conflicts of interest: None to report.

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