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Published on: February 23, 2014
Nosocomial pneumonia in the pediatric trauma patient: a single center's experience
J C Patel1, D L Mollitt, P Pieper
1Department of Surgery, University of Florida, Health Science Center Jacksonville, 32209-6511, USA.
Insights
Nosocomial pneumonia occurred in 5.5% of critically injured children, increasing with mechanical ventilation. This complication did not significantly impact mortality in pediatric trauma patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Trauma surgery outcomes
Background:
- Nosocomial pneumonia is a significant concern in intensive care settings.
- Understanding its occurrence in critically injured children is crucial for improving outcomes.
- Previous studies have focused less on this specific pediatric population.
Purpose of the Study:
- To determine the frequency, patterns, and outcomes of nosocomial pneumonia in critically injured children.
- To analyze the microbiological profile of nosocomial pneumonia based on the timing of onset.
- To compare outcomes, including mortality, between children with and without nosocomial pneumonia.
Main Methods:
- Retrospective review of prospectively collected data from a Level I university trauma center's pediatric intensive care unit.
- Analysis of 523 consecutive critically injured children admitted over an 80-month period.
- Identification of nosocomial pneumonia episodes and associated clinical and microbiological data.
Main Results:
- Nosocomial pneumonia was identified in 5.5% of critically injured children (29/523).
- Mechanical ventilation significantly increased the frequency rate to 13%.
- Common pathogens included Staphylococcus aureus, Haemophilus influenzae, Pseudomonas, and Enterobacter, with variations based on pneumonia onset (early vs. late).
- Children with nosocomial pneumonia had higher Injury Severity Scores and longer hospital stays but similar mortality rates compared to those without pneumonia.
Conclusions:
- Nosocomial pneumonia affects a small but significant proportion of critically injured children.
- Mechanical ventilation is a major risk factor, and pathogen profiles differ by onset timing.
- Unlike in adults, mortality does not appear significantly increased by nosocomial pneumonia in this pediatric cohort.
- Further multi-center studies are recommended to validate these findings.
Objectives:
To evaluate a single center's experience with the frequency rate, patterns of occurrence, and impact on outcome of nosocomial pneumonia in the critically injured child.
Design:
Retrospective review of prospectively collected data.
Setting:
Level I university trauma center with a pediatric trauma intensive care unit.
Patients:
A total of 523 consecutive critically injured children admitted to the pediatric intensive care unit during an 80-month interval.
Measurements And Results:
Thirty-five episodes of nosocomial pneumonia were identified in 29 children (frequency rate of 5.5%). The mean age of the children was 9.2 yrs, and the mean Injury Severity Score was 27 +/- 9. In 91% of patients (26 children), nosocomial pneumonia was associated with mechanical ventilation. This represented a 13% frequency rate in injured children who were ventilated during the study period. The most common organisms recovered were Staphylococcus aureus (21%), Haemophilus influenzae (19%), Pseudomonas (11%), and Enterobacter (11%). Early pneumonia (diagnosed < or = 7 days after injury) was predominantly caused by Haemophilus species. In contrast, Enterobacter and/or Pseudomonas were isolated primarily in late pneumonia (diagnosed >7 days after injury). Staphylococcus was prominent throughout the hospitalization. Overall, children with nosocomial pneumonia were more severely injured (Injury Severity Score 27 vs. 17, p < .001) and had a longer hospital stay (26 vs. 7 days, p < .001). Despite this, mortality (6.9% vs. 7.9%, p = NS) was not significantly different from injured children without pneumonia.
Conclusions:
In this study of a single pediatric trauma center, nosocomial pneumonia occurred in a small but significant percentage of injured children. The frequency rate increased two- to three-fold with mechanical ventilation. Microbiology varied with day of onset. In contrast to the adult, mortality did not seem to be significantly altered by this complication. Analysis of additional pediatric trauma centers is encouraged to confirm these characteristics of nosocomial pneumonia in the injured child.
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