title: Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: a meta-analysis.
abstract: 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.
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Tan
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Xian-Yang
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Zhang
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Peng-Zhou
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Xue
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Ya
authors.initials: Y
authors.lastname: Ling-Huang
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li-Li
authors.affiliation: School of Public Health and Management, Chongqing Medical University, Chongqing, China. Electronic address: jfqiu@126.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Fu-Qiu
mesh_terms: D001419:Bacteria / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D002681:China / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009026:Mortality; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology*
keywords: Antibiotics; Bacteria; NICU; Systematic review; Ventilator-associated pneumonia