Ventilator-Associated Pneumonia in Hospitalized Newborns in a Neonatal Intensive Care Unit

Abstract

Background: Ventilator-associated pneumonia (VAP) develops in mechanically ventilated patients 48 hours after putting the patients on the ventilator. VAP is the second most common nosocomial infection in neonatal intensive care units (NICU). Objectives: The current study was conducted to determine the rate, microbiological characteristics and outcome of VAP in neonates admitted in the NICU of Shohada-e-Tajrish Hospital. Patients and Methods:: A prospective cross-sectional study was conducted from Oct 2009 to Sep 2010, on all neonates receiving mechanical ventilation for more than 48h in the NICU. Clinical and paraclinical data were documented and tracheal secretions were collected by nonbronchoscopic bronchoalveolar lavage (NB-BAL) method for the smear and culture. Colony count and antibiograms were done on all culture-positive specimens. Results: From 103 patients admitted In the NICU, a total of 66 patients were intubated for 48h or more. VAP occurred in 33.3% of the mechanically ventilated neonates. Microorganisms associated with VAP included: Klebsiella species in 68.1%, Acinetobacter spp. and Enterococcus spp. in 13.6%, and Candida spp. in 4.5%. Lower gestational age and birth weight, longer duration of hospital stay and prolonged ventilator need had a significant relationship with VAP. Mortality rate was 6.8% in the ventilated infants without VAP, while 22.7% of the neonates who developed VAP, died. Conclusions: VAP was common in mechanically ventilated infants in the NICU of the hospital and was associated with increased mortality. Further studies are needed to investigate the prevention of VAP in mechanically ventilated neonates.