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Ventilator Associated Pneumonia in Pediatric Intensive Care Unit: Incidence, Risk Factors and Etiological Agents
Gnanaguru Vijay1, Anirban Mandal1, Jhuma Sankar1
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Insights
Ventilator associated pneumonia (VAP) affects 38.4% of children on mechanical ventilation, with Gram-negative bacilli as key pathogens. Proton pump inhibitors and enteral feeding are significant risk factors for VAP development.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Respiratory medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in pediatric intensive care units (PICUs).
- Understanding the incidence, causative agents, and risk factors for VAP is crucial for effective prevention and management in children.
Purpose of the Study:
- To determine the incidence, etiology, and risk factors associated with ventilator-associated pneumonia (VAP) in children admitted to a tertiary care PICU.
- To identify independent risk factors for VAP through bivariate and multivariate analysis.
Main Methods:
- A prospective cohort study involving 86 children requiring mechanical ventilation for over 24 hours in a North Indian PICU.
- Daily assessment for VAP using CDC criteria, with chest radiography and microbiological sampling for suspected cases.
- Bivariate and multivariate analyses were performed to identify risk factors.
Main Results:
- The incidence of VAP was 38.4% (microbiologically confirmed: 24.4%), and ventilator-associated tracheobronchitis (VAT) was 11.6%.
- Acinetobacter (47%) and Pseudomonas (28%) were the most common pathogens.
- Independent risk factors for VAP included proton pump inhibitor use (OR 8.47) and enteral feeding (OR 12.2).
Conclusions:
- VAP is a common complication in mechanically ventilated children, primarily caused by Gram-negative bacilli.
- Ventilator-associated tracheobronchitis is an emerging concern, and its early recognition and treatment may prevent VAP.
- Proton pump inhibitors and enteral feeding are significant modifiable risk factors for VAP in this pediatric population.
Objectives:
To study the incidence, etiology and risk factors associated with ventilator associated pneumonia (VAP) in children.
Methods:
This prospective cohort study was conducted on patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care institute of North India, from June 2012 through March 2014, who received mechanical ventilation for more than 24 h. All enrolled children were assessed daily for development of ventilator associated pneumonia (VAP) using the case definition given by Centers for Disease Control and Prevention (CDC). Chest radiograph and microbiologic samplings were performed in children suspected to have VAP. Risk factors associated with VAP were calculated by doing bivariate and multivariate analysis.
Results:
A total of 128 patients were screened and 86 were enrolled (median age 30 mo 95% CI 4.0-84.0; 72% boys). The most common admitting diagnosis was sepsis (16%) followed by acyanotic congenital heart disease with pneumonia (14%) and the most common indication for ventilation was respiratory failure (45.3%). The incidence of VAP according to CDC criteria was 38.4%, while the incidence of microbiologically confirmed VAP was 24.4%. The incidence of ventilator associated tracheobronchitis (VAT) was found to be 11.6%. Acinetobacter was the most frequently isolated organism (47%) followed by Pseudomonas (28%), Klebsiella (15%), E. coli (5%) and Enterobacter (5%). Risk factors for VAP on bivariate analysis were use of proton pump inhibitor (PPI) (p = 0.027, OR 5.2, 95% CI 1.1-24.3), enteral feeding (p < 0.001, OR 6.5, 95% CI 2.1-19.4) and re-intubation (p = 0.024, OR 3.3 and 95% CI 1.1-9.6). On multivariate analysis, use of PPI (p = 0.03, OR 8.47, 95% CI 1.19-60.33) and enteral feeding (p < 0.001, OR 12.2, 95% CI 2.58-57.78) were identified as independent risk factors for VAP.
Conclusions:
Ventilator associated pneumonia is an important complication in children receiving mechanical ventilation in PICU and Gram negative bacilli (Acinetobacter and Pseudomonas) being the important causative agents. Ventilator associated tracheobronchitis is an emerging entity; recognition and treatment of same might prevent the development of VAP.
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