Study of Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

• Published in: Indian journal of pediatrics Vol. 81; no. 11; pp. 1182 - 1186
• Main Authors: Balasubramanian, Pooja, Tullu, Milind S.
• Format: Journal Article
• Language: English
• Published: India Springer India 01.11.2014; Springer
• Subjects: Biological and medical sciences; Child, Preschool; Cross Infection - epidemiology; Cross Infection - microbiology; Female; General aspects; Gynecology; Human infectious diseases. Experimental studies and models; Humans; Incidence; India - epidemiology; Infant; Infectious diseases; Intensive Care Units, Pediatric; Male; Medical sciences; Medicine; Medicine & Public Health; Original Article; Pediatrics; Pneumology; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - microbiology; Prospective Studies; Respiration, Artificial; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; India; Bacterial; Ventilator; Critical; Nosocomial pneumonia; Lung; Intensive care unit; Human; Lung disease; Nosocomial infection; Pediatrics; Pneumonia; Respiratory disease; Artificial ventilation; Infection; Bacteriosis; Tropical medicine; Child
• ISSN: 0019-5456; 0973-7693; 0973-7693
• DOI: 10.1007/s12098-014-1444-1

Objectives To determine the incidence, etiology, risk factors and outcome of ventilator associated pneumonia (VAP) among mechanically ventilated patients. Methods All PICU patients who were mechanically ventilated for >48 h were consecutively enrolled. The development of VAP was defined by the radiological and clinical criteria described by the Center for Disease Control and Prevention/National Nosocomial Infection Surveillance (CDC/NNIS) (2003). The risk factors for VAP were determined by univariate and multivariate analysis using appropriate statistical methods. Results The median age of the subjects ( N  = 232) was nine mo with a male to female ratio of 1.3:1. Of 232 subjects enrolled, there were 15 episodes of VAP in 14 patients (frequency of 6.03 %) with a mean VAP rate of 6.3/1,000 ventilator days. Eight of the 15 VAP episodes showed positive endotracheal culture with Gram negative organisms as the predominant isolate with Acinetobacter being the commonest organism isolated (62.5 %). Neuromuscular disease ( P  = 0.005), histamine-2 receptor blockers ( P  = 0.0001), tracheostomy ( P  = 0.0001), and positive blood culture growth ( P  = 0.0008) were found to be significantly associated with VAP (univariate analysis). VAP patients had a significantly longer duration of mechanical ventilation (22.5 vs. 5 median days; P  < 0.001), longer PICU stay (23.25 vs. 6.5 median days; P  < 0.001) and longer hospital stay (43.75 vs. 13.25 median days; P  < 0.001). On multivariate analysis, only positive blood culture growth was a risk factor for VAP. The mortality rate of VAP was 42.8 % (not higher than those without VAP). Conclusions Frequency of VAP was 6.03 % with neuromuscular disease, histamine-2 receptor blockers, tracheostomy and positive blood culture being risk factors for VAP.