Related Experiment Video
Updated: Aug 28, 2025
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia in PICU - how are we doing?
L van Wyk1, J T Applegate2, S Salie1,2
1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa.
Insights
Ventilator-associated pneumonia (VAP) rates in pediatric intensive care units remain unchanged. Improving adherence to VAP bundles is crucial for reducing infection rates and enhancing patient outcomes.
Area of Science:
- Pediatric Intensive Care
- Infection Control
- Hospital-Acquired Infections
Background:
- Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in pediatric intensive care units (PICUs).
- Previous interventions in 2013, including a VAP bundle and coordinator, initially reduced VAP rates.
- Ongoing evaluation is necessary to assess the sustained efficacy of these quality improvement initiatives.
Purpose of the Study:
- To evaluate the VAP rate in a PICU between 2017 and 2018.
- To identify the primary causative microorganisms of VAP during this period.
- To analyze antibiotic sensitivity and resistance patterns for effective treatment strategies.
Main Methods:
- A retrospective, descriptive study design was employed.
- Data were collected from the existing PICU VAP database and patient clinical records.
- Analysis included VAP incidence, causative organisms, and antibiotic susceptibility.
Main Results:
- A total of 31 VAP cases were identified over the two-year study period.
- VAP rates were 4.0/1000 ventilator days in 2017 and 5.4/1000 ventilator days in 2018.
- Extended-spectrum beta-lactamase (ESBL) *Klebsiella pneumoniae* was the most common organism, sensitive to amikacin and carbapenems.
Conclusions:
- VAP rates have not decreased since 2013, indicating a need for improved interventions.
- Enhanced compliance with the VAP bundle is essential to effectively reduce VAP incidence.
- *Klebsiella pneumoniae* and *Pseudomonas aeruginosa* remain common pathogens, supporting the empiric use of piptazobactam and amikacin.
Background:
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in children, leading to an increase in morbidity and mortality. A previous study in 2013 showed that VAP rates decreased dramatically after implementation of a VAP bundle and appointing a VAP coordinator. As part of a 'Plan, Do, Study, Act' cycle, it was necessary to evaluate the efficacy of these interventions.
Objectives:
To evaluate the VAP rate in the paediatric intensive care unit (PICU) over 2 years (2017 - 2018), and to describe the causative organisms and antibiotic sensitivity/resistance patterns during this period.
Methods:
This was a retrospective, descriptive study using the existing PICU VAP database as well as clinical folders.
Results:
Over the 2 years, 31 VAP cases were identified. The VAP rate for 2017 was 4.0/1 000 ventilator days and 5.4/1 000 ventilator days for 2018. Compliance with the VAP bundle was 68% in 2017 and 70% in 2018. The median (interquartile range (IQR)) duration of ventilation in 2017 was 9 (6 -12) days and 15 (11 - 28) days in 2018. The median (IQR) length of PICU stay in 2017 was 11 (8 - 22) days and 25 (17 - 37) days in 2018. The most common cultured organism was an extended-spectrum beta-lactamase (ESBL) Klebsiella pneumoniae sensitive to amikacin and carbapenems.
Conclusion:
Our VAP rate has not decreased since 2013. It is imperative that we improve compliance with the VAP bundle, in order to reduce VAP rates. K. pneumoniae and Pseudomonas aeruginosa were the most common organisms causing VAPs and empiric use of piptazobactam and amikacin is still appropriate.
Contributions Of The Study:
This study highlights the need for ongoing evaluation of quality improvement initiatives in PICU, considering that VAP rates remained largely unchanged from 2013 to 2018.
More Related Videos
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Pneumonia III: Complications and Assessment
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...