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Nosocomial pneumonia and tracheitis in a pediatric intensive care unit: a prospective study
M J Fayon1, M Tucci, J Lacroix
1Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Québec, Canada.
Insights
Bacterial nosocomial pneumonia (BNP) and tracheitis (BNT) are rare in pediatric intensive care units. BNP leads to significant complications, including death, while BNT requires reintubation, necessitating focused attention on these infections in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Hospital epidemiology
Background:
- Nosocomial respiratory infections pose a risk to critically ill children.
- Bacterial nosocomial pneumonia (BNP) and tracheitis (BNT) are specific concerns.
- Understanding their incidence and risk factors is crucial for prevention and management.
Purpose of the Study:
- To determine the incidence, risk markers, risk factors, and complications of BNP and BNT in a pediatric intensive care unit (PICU).
- To identify independent risk factors for developing BNP and BNT.
- To analyze the clinical outcomes and complications associated with these infections.
Main Methods:
- Prospective cohort study of 1,114 consecutive admissions to a multidisciplinary pediatric ICU.
- Diagnosis of BNP and BNT based on CDC criteria, confirmed by expert consensus.
- Multivariate analysis to identify independent risk factors for BNP and BNT.
Main Results:
- The incidence of combined BNP and BNT was 3.0% (BNP: 1.2%, BNT: 1.8%).
- Independent risk factors for BNP included immunodeficiency, immunosuppression, and neuromuscular blockade.
- Independent risk factors for BNT included head trauma and respiratory failure. Common pathogens were Gram-negative bacteria and Staphylococcus aureus.
- BNP resulted in death or multiple organ system failure in 8% of cases, while BNT led to a 24% reintubation rate.
Conclusions:
- Nosocomial bacterial respiratory infections are uncommon in critically ill children.
- BNP is associated with severe complications and mortality.
- BNT, though less severe in terms of mortality, has a high reintubation rate, warranting increased clinical attention.
Abstract:
We conducted a prospective study in the multidisciplinary pediatric intensive care unit (pediatric ICU) of a tertiary-care university hospital in order to determine the incidence, risk markers, risk factors, and complications related to bacterial nosocomial pneumonia (BNP) and tracheitis (BNT) in children. A cohort of 1,114 consecutive admissions to the pediatric ICU was enrolled over a 56-wk period; 154 cases were excluded mostly (75%) because they already had a respiratory infection at entry. The final sample included 960 admissions (831 patients). Diagnosis of BNP or BNT was based on Centers for Disease Control of Atlanta criteria using a consensus method involving three experts, who also attributed complications to BNP and BNT. A total of 29 BNP and BNT (3.0%; 95% CI: 1.1 to 4.1%) were diagnosed (BNP: 1.2%, 95% CI: 0.7 to 1.9%; BNT: 1.8%, 95% CI: 0.8 to 2.6%). Three factors were retained by multivariate analysis as independent risk factors or markers for BNP (immunodeficiency, immunosuppression, and neuromuscular blockade), and two for BNT (head trauma and respiratory failure). Gram-negative bacteria and Staphylococcus aureus were the microorganisms most frequently found in the tracheal aspirates. Prescription of antibiotics was commonly attributable to BNP (75%) and BNT (59%). Death, as well as multiple organ system failure, resulted from BNP in 8% of cases, but never from BNT. In BNT, the reintubation rate was 24%. Nosocomial bacterial respiratory infections are rare in critically ill children. However, BNP causes significant complications, and more attention should be focused on BNT in the critically ill child.