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Published on: June 28, 2018
Ventilator-Associated Pneumonia in Paediatric Intensive Care Unit Patients: Microbiological Profile, Risk Factors,
Piyali Bhattacharya1, Arvind Kumar2, Sanat Kumar Ghosh3
1Paediatrics, Mata Gujri Memorial (MGM) Medical College, Kishanganj, IND.
Insights
Ventilator-associated pneumonia (VAP) in children is often caused by Gram-negative bacteria, with prolonged mechanical ventilation being a key risk factor. While VAP increases hospital stay, this study found no significant association with mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in pediatric intensive care units (PICUs), associated with high morbidity and mortality.
- Understanding the specific etiological agents, risk factors, and outcomes of VAP is crucial for effective prevention and management strategies in pediatric critical care settings.
Purpose of the Study:
- To investigate the microbiological profile of VAP in children admitted to a pediatric intensive care unit.
- To identify risk factors associated with the development of VAP in this patient population.
- To determine the outcomes, including mortality, associated with VAP in children.
Main Methods:
- An observational cross-sectional study was conducted involving 37 diagnosed cases of VAP in children.
- VAP diagnosis was based on a clinical pulmonary infection score greater than 6, confirmed by tracheal culture and chest X-ray.
- Data on patient demographics, clinical factors, microbiological findings, and outcomes were collected and analyzed.
Main Results:
- The incidence of VAP was 36.2%, with the 1-5 year age group being most affected.
- The most common causative organisms were *Pseudomonas aeruginosa* (29.8%), *Klebsiella pneumoniae* (21.6%), *Staphylococcus aureus* (18.9%), and *Acinetobacter* (13.5%).
- Factors significantly associated with VAP included steroid use, sedation, reintubation, and a longer duration of mechanical ventilation (mean 15 days vs. 7 days). Mortality was 48.54% in VAP cases, not significantly different from non-VAP cases (p=0.0843).
Conclusions:
- VAP in children is frequently caused by Gram-negative bacteria, particularly in the context of prolonged mechanical ventilation.
- VAP is associated with extended mechanical ventilation, PICU stay, and overall hospital stay, but not significantly with increased mortality.
- Targeted preventive strategies focusing on risk factors like prolonged ventilation, steroid use, and sedation are warranted to reduce VAP incidence in PICUs.
Abstract:
Introduction Ventilator-associated pneumonia (VAP) is one of the dreaded events in sick children who are ventilated in the paediatric intensive care unit (PICU) and has a high mortality rate. So, there is a need to know the causative organisms, risk factors, and possible predictors in a particular PICU for prevention, early identification, and treatment to decrease morbidity and mortality. This study was planned with the objectives to determine the microbiological profile, associated risk factors, and outcome of VAP in children. Methods In this observational cross-sectional study conducted at Dr. B C Roy Post Graduate Institute of Paediatric Science, Kolkata, India, 37 VAP cases were diagnosed using clinical pulmonary infection score >6 and confirmed by tracheal culture and X-ray. Results The number of paediatric patients suffering from VAP was 37 (36.2%). The commonest age group involvement was one to five years. The microbiological profile included Pseudomonas aeruginosa (29.8%) and Klebsiella pneumoniae (21.6%) as the commonest organisms followed by Staphylococcus aureus (18.9%) and Acinetobacter (13.5%). The factors significantly associated with the increased frequency of VAP were the use of steroids, sedation, and reintubation. The mean duration of mechanical ventilation (MV) in VAP was 15 days compared to non-VAP (seven days), and the longer duration of ventilation was significantly associated with VAP (p=0.00001). Mortality in VAP was 48.54% compared to non-VAP (55.84%) with no significant association (p=0.0843) of VAP with death occurrence. Conclusion The present study showed that VAP occurrence is associated with prolonged duration of MV, PICU stay, and hospital stay but is not significantly associated with mortality. It also indicated that gram-negative bacteria were the most common VAP causative organisms in this cohort.
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