Study of Ventilator-associated Pneumonia in a Pediatric Intensive Care Unit

Objectives: To determine the incidence, etiology, risk factors and outcome of ventilator associated pneumonia (VAP) among mechanically ventilated patients.

Methods: All PICU patients who were mechanically ventilated for >48 h were consecutively enrolled. The development of VAP was defined by the radiological and clinical criteria described by the Center for Disease Control and Prevention/National Nosocomial Infection Surveillance (CDC/NNIS) (2003). The risk factors for VAP were determined by univariate and multivariate analysis using appropriate statistical methods.

Results: The median age of the subjects (N = 232) was nine mo with a male to female ratio of 1.3:1. Of 232 subjects enrolled, there were 15 episodes of VAP in 14 patients (frequency of 6.03 %) with a mean VAP rate of 6.3/1,000 ventilator days. Eight of the 15 VAP episodes showed positive endotracheal culture with Gram negative organisms as the predominant isolate with Acinetobacter being the commonest organism isolated (62.5 %). Neuromuscular disease (P = 0.005), histamine-2 receptor blockers (P = 0.0001), tracheostomy (P = 0.0001), and positive blood culture growth (P = 0.0008) were found to be significantly associated with VAP (univariate analysis). VAP patients had a significantly longer duration of mechanical ventilation (22.5 vs. 5 median days; P < 0.001), longer PICU stay (23.25 vs. 6.5 median days; P < 0.001) and longer hospital stay (43.75 vs. 13.25 median days; P < 0.001). On multivariate analysis, only positive blood culture growth was a risk factor for VAP. The mortality rate of VAP was 42.8 % (not higher than those without VAP).

Conclusions: Frequency of VAP was 6.03 % with neuromuscular disease, histamine-2 receptor blockers, tracheostomy and positive blood culture being risk factors for VAP.