Objective: To analyze the pathogen distribution and risk factors for carbapenem-resistant gram-negative bacteria (CRGNB) in neonates with ventilator-associated pneumonia (VAP). Methods: A total of 75 neonates with VAP caused by CRGNB infection in Huangshi Maternal and Child Health Hospital and Huangshi Central Hospital from 2018 to 2020 were chosen as CRGNB group

and 150 neonates with VAP caused by carbapenem-sensitive gram-negative bacteria (CSGNB) admitted to the same ward at the same time were randomly selected according to the ratio of 1 ∶ 2 as CSGNB group. Retrospective case-control study was conducted to analyze the risk factors for CRGNB infection. Results: CRGNB strains were mainly Klebsiella pneumoniae

Escherichia coli

Acinetobacter baumannii and Pseudomonas aeruginosa in neonates with VAP. The composition ratio of Acinetobacter baumannii in CRGNB group was higher than that in CSGNB group

and that of Klebsiella pneumoniae was lower than that in CSGNB group (all P< 0. 05). Single factor analysis showed that there were statistically significant differences in low birth body mass (< 1

500 g)

1 min Apgar score ( < 7 points)

breathing machine ventilation time ( > 14 d)

types of used antimicrobial agents ( ⩾ 3 kinds)

antimicrobial drug use time (>14 d) and prenatal hospitalization history and prenatal use history of broad-spectrum antibiotics before 3 months between CRGNB and CSGNB group (all P < 0. 05). Multivariate logistic regression analysis showed that newborn body weight <1

500 g (OR=2. 04)

ventilator ventilation time >14 d (OR=2. 37)

types of used antimicrobial agents ⩾3 kinds (OR= 2. 11)

antibiotics medication time >14 d (OR = 2. 60) and prenatal 3 months of broad-spectrum antibiotics (OR = 1. 92) were independent risk factors for neonatal VAP infection with CRGNB. Conclusion: The incidence of GRGNB in neonates with VAP is associated with birth weight

ventilation time

kinds of combined antibiotics

time of antibiotics administration and the prenatal medication history of 3 months of broad-spectrum antibiotics. The clinical should timely take comprehensive prevention and control measures according to the risk factors of neonatal VAP infected by CRGNB.