Abstract
Background: Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient’s outcome in Pediatric Intensive Care Units (PICU). Objectives: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Materials and Methods: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. Results: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014). No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen) modifying agents (such as ranitidine or pantoprazole), presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087). Mortality rate was not statistically different between the VAP and control groups (p = 0.477). Conclusion: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.
Highlights
Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI)
There are some epidemiological studies that have been carried in neonatal intensive care units (NICU) in Iran [11], to the best of our knowledge, there is only one published study that has investigated the incidence of VAP in Iranian children in Pediatric Intensive Care Units (PICU) [5,12]
The primary aim of this study is to describe the incidence of VAP, and the secondary aim is to determine the effect of VAP on mortality, and to determine risk factors for VAP in the Mofid Children’s
Summary
Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient’s outcome in Pediatric Intensive Care Units (PICU). Objectives: The research on VAP in children is limited, especially in Iran; the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. Other important factors that may influence the reported rate include: study methodology [6,7], definition criteria (microbiological criteria versus non- microbiological criteria) [2,8], use of VAP prevention bundle programs [9], and medication practice in different PICUs [10]. There are some epidemiological studies that have been carried in neonatal intensive care units (NICU) in Iran [11], to the best of our knowledge, there is only one published study that has investigated the incidence of VAP in Iranian children in PICU [5,12]
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