PURPOSE: Ventilator-associated pneumonia (VAP) is the most common hospital acquired infection observed in patients require treatment in pediatric intensive care unit (PICU). Few data exist for pediatric patients with respect to risk factors and outcomes in Thailand. We determine prevalence, risk factors, and outcomes of VAP in PICU patients.
METHODS: A prospective observational study was conducted at PICU of the Chiang Mai University Hospital, a teaching hospital in northern Thailand. All patients who were admitted to PICU from March, 2006 to September, 2007 were included into the study. The criteria for VAP as defined by National Nosocomial Infections Surveillance (NNIS) System were used.The primary outcome measured was the development of VAP.Secondary outcome were risk factors, death, hospital and PICU lengths of stay.
RESULTS: Thirty-three cases of 287(11.5%) mechanically ventilated patients developed VAP. The rate of VAP was 7.29 episodes/1000 ventilator days. Among VAP patients, the mean age was 2.5 ± 3.8 years. Patients with VAP were younger than patients without VAP and were more likely to have underlying chronic lung disease (72.7% vs 54.1%, p=.05) and congenital heart disease (48.5% vs 21.1%, p=.024). The three most common causative organisms responsible for VAP were Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. On stepwise logistic regression analysis, independent predictors of VAP were reintubation, tracheostomy, prior antibiotic use, and use of sedatives. The patients who developed VAP had longer duration of PICU stay (p<.001), longer duration of hospital days (p<.001) and higher mortality (p< .001) than patients who did not develop VAP.
CONCLUSION: VAP occurred at significant rate in mechanically ventilated PICU patients. It was associated with risk factors such as reintubation, tracheostomy, prior antibiotic use and use of sedatives. It resulted in excessive mortality, prolonged length of PICU and hospital stay.
CLINICAL IMPLICATIONS: The study of prevalence and risks of developing VAP is crucial in the care of critically ill children.Closely monitoring among high-risk patients and developing intervention to reduce risk factors will improve outcome and reduce mortality.
DISCLOSURE: Somrak Rangkakulnuwat, No Financial Disclosure Information; No Product/Research Disclosure Information