Ventilator Associated Pneumonia in Pediatric Intensive Care Unit: Incidence, Risk Factors and Etiological Agents

  • Gnanaguru Vijay
  • Anirban Mandal
  • Jhuma Sankar
  • Arti Kapil
  • Rakesh Lodha
  • S. K. Kabra
Original Article

Abstract

Objectives

To study the incidence, etiology and risk factors associated with ventilator associated pneumonia (VAP) in children.

Methods

This prospective cohort study was conducted on patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care institute of North India, from June 2012 through March 2014, who received mechanical ventilation for more than 24 h. All enrolled children were assessed daily for development of ventilator associated pneumonia (VAP) using the case definition given by Centers for Disease Control and Prevention (CDC). Chest radiograph and microbiologic samplings were performed in children suspected to have VAP. Risk factors associated with VAP were calculated by doing bivariate and multivariate analysis.

Results

A total of 128 patients were screened and 86 were enrolled (median age 30 mo 95% CI 4.0–84.0; 72% boys). The most common admitting diagnosis was sepsis (16%) followed by acyanotic congenital heart disease with pneumonia (14%) and the most common indication for ventilation was respiratory failure (45.3%). The incidence of VAP according to CDC criteria was 38.4%, while the incidence of microbiologically confirmed VAP was 24.4%. The incidence of ventilator associated tracheobronchitis (VAT) was found to be 11.6%. Acinetobacter was the most frequently isolated organism (47%) followed by Pseudomonas (28%), Klebsiella (15%), E. coli (5%) and Enterobacter (5%). Risk factors for VAP on bivariate analysis were use of proton pump inhibitor (PPI) (p = 0.027, OR 5.2, 95% CI 1.1–24.3), enteral feeding (p < 0.001, OR 6.5, 95% CI 2.1–19.4) and re-intubation (p = 0.024, OR 3.3 and 95% CI 1.1–9.6). On multivariate analysis, use of PPI (p = 0.03, OR 8.47, 95% CI 1.19–60.33) and enteral feeding (p < 0.001, OR 12.2, 95% CI 2.58–57.78) were identified as independent risk factors for VAP.

Conclusions

Ventilator associated pneumonia is an important complication in children receiving mechanical ventilation in PICU and Gram negative bacilli (Acinetobacter and Pseudomonas) being the important causative agents. Ventilator associated tracheobronchitis is an emerging entity; recognition and treatment of same might prevent the development of VAP.

Keywords

Acinetobacter Enteral feeding Proton pump inhibitor Ventilator associated pneumonia 

Notes

Contributions

VG: Developed protocol, data collection, manuscript writing; AM: Involved in data collection; JS: Involved in development of protocol, data analysis; AK: Involved in development of protocol and microbiology investigations; RL: Involved in protocol development, data analysis and manuscript writing and will act as guarantor for the paper; SKK: Involved in protocol development, data collection, analysis and manuscript writing.

Compliance with Ethical Standards

Conflict of Interest

None.

Supplementary material

12098_2018_2662_MOESM1_ESM.docx (80 kb)
Fig. S1 (DOCX 79 kb)
12098_2018_2662_MOESM2_ESM.docx (102 kb)
Fig. S2 (DOCX 102 kb)

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Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  • Gnanaguru Vijay
    • 1
  • Anirban Mandal
    • 1
  • Jhuma Sankar
    • 1
  • Arti Kapil
    • 2
  • Rakesh Lodha
    • 1
  • S. K. Kabra
    • 1
  1. 1.Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of MicrobiologyAll India Institute of Medical SciencesNew DelhiIndia

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