Ventilator associated pneumonia: incidence, profile and outcome in pediatric intensive care unit of tertiary care centre

Authors

  • Swati M. Gadappa Department of Pediatrics, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
  • Manas Kumar Behera Department of Pediatrics, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20183842

Keywords:

Outcome, Pneumonia, PICU, PIM3, Ventilator

Abstract

Background: Ventilator-Associated Pneumonia (VAP) refers to nosocomial pneumonia occurring 48 hours or more after initiation of mechanical ventilation (MV), with frequencies ranging from 15-45%. The incidence rates of VAP are higher in developing countries with limited resources. Early and late VAP differ in their pathogenesis, micro-organisms responsible, antibiotic sensitivity, outcome and treatment.

Methods: Retrospective cohort study of all critically ill children between 1 month to 12 years who were admitted and mechanically ventilated in our 8-bedded PICU between January 2015 to June 2016 and developed Ventilator associated pneumonia. PIM3 (Paediatric Index of Mortality 3) was calculated.  We compared early and late VAP for risk factors, length of stay on mechanical ventilation (LOS MV) and outcome. The data collected were compiled and tabulated.

Results: The incidence of VAP in this study was 40%. We found significant correlation between early and late VAP with parenteral nutrition (p = 0.001), presence of nasogastric tube (p = 0.012) and   mortality (p = 0.027). The LOS MV was Mean 7.25 days in early VAP, while 22.75 days in late VAP; which demonstrated significant correlation (p = 0.003). There was no significant correlation of PIM3 with VAP, reintubation and mortality. Most frequent organisms found in Early VAP were Acinetobacter baumannii and MRSA, whereas in late VAP Pseudomonas aeruginosa was commonest isolated organism.

Conclusions: VAP is a major cause of mortality in PICU. Late VAP was associated with longer length of stay on mechanical ventilation (LOS MV), higher mortality. This study thus emphasizes the need for prospective multicentric case-control studies for formulating and applying early preventive strategies in PICU to reduce VAP-related mortality. 

References

Liu B, Li SQ, Zhang SM, Xu P, Zhang X, Zhang YH, et al. Risk factors of ventilator-associated pneumonia in a paediatric intensive care unit: a systematic review and meta-analysis. J Thorac Dis. 2013;5(4):525-31.

Tang CW, Liu PY, Huang YF, Pan JY, Lee SS, Hsieh KS, et al. Ventilator-associated pneumonia after paediatric cardiac surgery in southern Taiwan. J Microbiol Immunol Infect. 2009;42(5):413-9.

Elward AM, Warren DK, Fraser VJ. Ventilator-associated pneumonia in paediatric intensive care unit patients: risk factors and outcome. Paediatr. 2002;109:758-64.

Patra PK, Jayashree M, Singhi S, Ray, Saxena AK. Nosocomial pneumonia in a pediatric intensive care unit. Indian Pediatr. 2007;44:511-8.

Sharma H, Singh D, Pooni P, Mohan U. A study profile of ventilator associated pneumonia in children in Punjab. J Trop Pediatr. 2009;55:393-5.

Gupta A, Kapil A, Lodha R, Sood S, Dhawan B, Das BK, et al. Burden of healthcare-associated infections in a paediatric intensive care unit of a developing country: a single centre experience using active surveillance. J Hosp Infect. 2011;78:323-6.

Rasslan O, Seliem ZS, Ghazi IA, Abd El Sabour M, El Kholy AA, Sadeq FM. Device-associated infection rates in adult and paediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health. 2012;5(6):394-402.

Papazian I, Bregeon I, Thirion X. Effects of ventilator-associated pneumonia on mortality and morbidity. AM J Respir Crit Care Med. 1996;154:91-7.

Luyt CE, Chastre J, Fagon JY, The VAP Trial Group. Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia. Intensive Care Med. 2004;30:844-52.

Croce MA, Swanson JM, Magnotti LJ, Claridge JA, Weinberg JA, Wood GC, et al. The futility of the clinical pılmonary infection scores in trauma patients. J Trauma. 2006;60:523-8

Australian and New Zealand Intensive Care Society (ANZICS). Information Booklet: PIM2 and PIM3 for the ANZPIC Registry; March 2016. Available at http://www.anzics.com.au/www.anzics.com.au/Downloads/PIM2%20%26%20PIM3%20Information%20Booklet%20Mar16.pdf

Aelami MH, Lotfi M, Zingg W. Ventilator-associated pneumonia in neonates, infants and children. Antimicrob. Resist Infect Control. 2014;3:30.

El-Kholy A, Saied T, Gaber M, Younan MA, Haleim MM, El-Sayed H, et al. Device-associated nosocomial infection rates in intensive care units at Cairo University hospitals: First step toward initiating surveillance programs in a resource-limited country. Am J Infect Control. 2012;40:e216-20.

Awasthi S, Tahazzul M, Ambast A, Govil YC, Jain A. Longer duration of mechanical ventilation was found to be associated with ventilator-associated pneumonia in children aged 1 month to 12 years in India. J Clin Epidemiol. 2013;66:62-6.

García J, Arriourtúa AB, Torre JA, Antón JG, Vicente JC, González CT. A national multicentre study on nosocomial infections in PICU. An Pediatr. Barc. 2014;80:28-33.

Bozorgmehr R, Bahrani V, Fatemi A. Ventilator-associated pneumonia and its responsible germs; an epidemiological study. Emerg. 2017;5(1):e26.

Memish ZA, Oni GA, Djazmati W. A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia. Am J Infect Control 2001;29:301-5.

Bilan N, Habibi, P. Does Re-intubation Increased Risk of Ventilator-Associated Pneumonia (VAP) in Paediatric Intensive Care Unit Patients? Int J Pediatr. 2015;3:411-5.

Naved SA, Siddique S, Khan FH. APACHE II score correlation with mortality and length of stay in an intensive care unit. J College Physicians Surg Pak. 2011;21:4-8.

Gupta A, Agrawal A, Mehrotra S, Singh A, Malik S, Khanna A. Incidence, risk stratification, antibiogram of pathogens isolated and clinical outcome of ventilator associated pneumonia. Indian J Crit Care Med. 2011;15:96-101.

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Published

2018-10-22

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Original Research Articles