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Abstract
In some hospitals the outcome of mechanically ventilated neonates may be more bad than good. This is mainly due to acquired nosocomial pneumonia during the period of mechanical ventilation.
Some recent studies said that there is a clear role of viruses in respiratory infections related to mechanical ventilation and the commonest one is RSV.
The aim of this study is to determine the incidence of infection by respiratory syncytial virus as a nosocomial respiratory infection in preterm infants submitted to mechanical ventilation in the neonatal intensive care units (NICUS) of Zagazig University Hospital and Benha Children Hospital.
The study was done in a period of 11 months during the period from November 2005 to September 2006, included fifty preterm babies admitted to the NICU with acute respiratory failure and submitted to mechanical ventilation.
All cases were subjected to the following:
1) History taking.
2) Clinical examination.
3) Laboratory investigations including:
●CBC
●CRP
●Blood gases
●Blood culture
●Chest X- rays
●Endotracheal tube (ETT) or Tracheal aspirate (TA) cultures
●Detection of RSV IgM antibodies by indirect immunofluorescent technique through two blood serum samples were collected during the mechanical ventilation period, with 7-10 days interval between the two samples.
In this study the main indications of submission to mechanical ventilation among cases were apnea in 21 cases (42%) followed by respiratory distress syndrome (RDs) in 15 cases (30%).
It was noticed that NCPAP was successful as an initial mode of mechanical ventilation in 4 of 6 cases with a total successful rate 67%, while it failed and replaced by IMV in 2 of 6 cases (33%).
This study detected the bacteriological profile of the +ve blood cultures of patients showed that there were positive blood cultures in 21 cases (42%) and the most prevalent microorganism was Staphylococcus aureus in 7 cases (14%) followed by Escherichia coli in 6 cases (12%).
On the other hand, tracheal aspirates cultures showed no growth in 31 cases (62%) and positive cultures were found in 19 cases (38%). the most prevalent microorganism detected in positive cultures was Klebsiella spp. in 7 cases (14%) followed by Escherichia coli in 5 cases (10%).
In our study all cases were negative for RSV IgM antibodies in the two blood samples with 7-10 days in between.
The most frequent complication among our cases was newly developed sepsis in 29 cases (58%), followed by ventilator-associated pneumonia in [VAP] 16 cases (32%).
In our study it is revealed that the presence of positive blood and tracheal aspirates cultures at the same time was occurred in 13 cases (68%) but the similarity with the same organism was detected in only 7 cases (14%) of studied cases. It indicates that blood culture is of limited value in detection of the causative organism of VAP.
On the other hand there were positive tracheal aspirates [TA] cultures in spite of the negativity of CRP values in 10 cases (52.6%), which indicates contamination of TA specimens by pharyngeal flora.