An Evaluation of Various Ventilator-Associated Infection Criteria in a PICU.

Abstract

To describe characteristics and overlap associated with various ventilator-associated infection criteria in the PICU. Retrospective observational study. A quaternary care children's hospital PICU. Children ventilated more than 48 hours, excluding patients with tracheostomy. None. Ventilator-associated infection, including pneumonia, infection-related ventilator-associated condition, tracheobronchitis, and lower respiratory tract infection were defined according to criteria from the Centers for Disease Control and Prevention or medical literature. Clinical data were abstracted to assign diagnoses of each ventilator-associated infection. In 300 episodes of mechanical ventilation, there were 30 individual episodes of ventilator-associated infection. Nine episodes met more than one definition. Rates per 1,000 ventilator days were 2.60 for ventilator-associated pneumonia, 2.16 for infection-related ventilator-associated condition, 5.19 for ventilator-associated tracheobronchitis, and 6.92 for lower respiratory tract infection. The rate of any ventilator-associated infection was 12.98 per 1,000 ventilator days. Individual criteria had similar risk factors and outcomes. Risk factors for development of any ventilator-associated infection included older age (p = 0.003) and trauma (p = 0.007), while less cardiac surgery patients developed ventilator-associated infection (p = 0.015). On multivariate analysis, trauma was the only independent risk factor (adjusted odds ratio, 3.10; 95% CI, 1.15-8.38). Developing any ventilator-associated infection was associated with longer duration of mechanical ventilation (p < 0.001) and longer PICU length of stay (p < 0.001) but not PICU mortality (p = 0.523). There is little overlap in diagnosis of various ventilator-associated infection. However, the risk factors and outcomes associated with individual criteria are similar, indicating that they may have validity in identifying true pathology. Ventilator-associated infection in general is likely a larger problem than indicated by low hospital-reported rates of ventilator-associated pneumonia. There is clinical confusion due to the presence of several diagnostic criteria for ventilator-associated infection. Developing a more inclusive and clinically relevant criterion for diagnosing ventilator-associated infection is warranted to accurately assess their impact and improve guidance for clinicians in evaluating and treating ventilator-associated infection.