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Ventilator associated pneumonia due to carbapenem resistant microorganisms in children

Soner S Kara1, Meltem Polat2, Anil Tapisiz2

  • 1Unit of Pediatric Infectious Diseases, Medical Faculty, Gazi University, Ankara, Turkey - drsoner@yahoo.com.

Minerva Pediatrica
|July 4, 2019
PubMed
Abstract

Insights

Broad-spectrum antibiotic use increases the risk of ventilator-associated pneumonia (VAP) in children caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA). Prior use of cefepime and colistin were independently associated with CRPA VAP.

Area of Science:

  • Pediatric critical care medicine
  • Infectious diseases
  • Antimicrobial resistance

Background:

  • Carbapenem-resistant pathogens pose a significant threat, particularly in hospitalized patients.
  • Acinetobacter baumanii (AB) and Pseudomonas aeruginosa (PA) are key causes of ventilator-associated pneumonia (VAP), often exhibiting high carbapenem resistance.
  • Ventilator-associated pneumonia (VAP) in children due to carbapenem-resistant Acinetobacter baumanii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) requires investigation into associated risk factors.

Purpose of the Study:

  • To identify risk factors for VAP caused by CRAB and CRPA in pediatric patients.
  • To analyze the association between previous antibiotic use and the development of CRPA and CRAB VAP.
  • To inform clinical practice and infection control strategies for pediatric VAP.

Main Methods:

  • A prospective observational study was conducted from 2009 to 2013 at Gazi University Hospital.
  • Included were pediatric patients (1 month to 12 years) in the Pediatric Intensive Care Unit (PICU) diagnosed with VAP due to AB and PA.
  • Univariate and regression analyses were used to identify risk factors associated with CRPA and CRAB VAP.

Main Results:

  • Of 126 VAP episodes, 58 were due to AB (93.1% carbapenem-resistant) and 68 to PA (51.5% carbapenem-resistant).
  • Univariate analysis linked CRPA VAP to longer PICU stays, central venous catheters, and prior use of cefepime, ciprofloxacin, colistin, and teicoplanin.
  • Previous cefepime and colistin use were independently associated with CRPA VAP (OR 2.11 and 2.33, respectively). No significant risk factors were found for CRAB VAP.

Conclusions:

  • Broad-spectrum antibiotic usage is a primary risk factor for VAP caused by CRPA in children.
  • Targeted antibiotic stewardship and infection control measures are crucial for preventing CRPA VAP.
  • Further research is needed to elucidate risk factors for CRAB VAP in pediatric populations.

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