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Updated: Apr 23, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia
Paulina Mariki1, Neil Rellosa1, Angela Wratney2
1Division of Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC.
Insights
Endotracheal Gram
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a critical patient safety concern.
- Accurate VAP diagnosis in pediatric patients presents significant challenges.
- Current diagnostic methods may lack precision in pediatric intensive care settings.
Purpose of the Study:
- To assess the feasibility of using endotracheal Gram's stain and culture to support VAP diagnosis in pediatric patients.
- To evaluate the utility of a modified microbiologic criterion for VAP identification.
- To determine the impact of culture results on antimicrobial therapy.
Main Methods:
- Retrospective cohort study design.
- Inclusion of pediatric intensive care and cardiac intensive care unit patients with positive endotracheal cultures and specific inflammatory markers.
- Review of medical records for clinical and radiographic VAP criteria (CDC criteria).
- Collection of antimicrobial use data before and after specimen collection.
Main Results:
- 28% of included patients met both clinical and radiographic VAP criteria.
- An additional 63% met either clinical or radiographic criteria, but not both.
- Endotracheal culture results led to altered antimicrobial therapy in 66% of patients.
- The majority of patients (63%) were on antibiotics when specimens were collected.
Conclusions:
- Endotracheal Gram's stain and culture are feasible for diagnosing pediatric VAP.
- This approach holds potential for standardizing VAP surveillance and management in pediatric populations.
- Microbiologic data from endotracheal specimens can guide antimicrobial treatment decisions.
Background:
Prevention of ventilator-associated pneumonia (VAP) is a major patient safety goal, but accurate identification of VAP in pediatric patients remains challenging.
Methods:
We performed a retrospective cohort study to demonstrate feasibility of endotracheal culture and Gram's stain to support VAP diagnosis. Pediatric intensive care unit and cardiac intensive care unit patients with ≥ 1 endotracheal specimen having growth of ≥ 1 organism in conjunction with moderate/many polymorphonuclear leukocytes (ie, the modified microbiologic criterion) were included. Medical records were reviewed for presence/absence of clinical and radiographic Centers for Disease Control and Prevention (CDC) criteria for VAP. Antimicrobial use data were collected before and after culture results were known.
Results:
Of 102 patients meeting inclusion criteria, 28% (n = 28) also met both clinical and radiographic CDC criteria for VAP (ie, diagnosis of PNU2). An additional 63% (n = 64) met clinical (36%; n = 37) or radiographic (27%; n = 27) criteria, but not both. Ten patients (9%) had neither clinical nor radiographic criteria for VAP. The majority (63%; n = 64) were receiving antibiotics at time of endotracheal specimen collection. Culture identification resulted in altered antimicrobial therapy in 66% of patients (n = 67).
Conclusions:
Our study demonstrates the feasibility of endotracheal Gram's stain and culture for diagnosis of pediatric VAP that could potentially standardize accurate surveillance and management of pediatric VAP.
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