Ventilator associated pneumonia: incidence, profile and outcome in pediatric intensive care unit of tertiary care centre

Abstract

Background: Ventilator-Associated Pneumonia (VAP) refers to nosocomial pneumonia occurring 48 hours or more after initiation of mechanical ventilation (MV), with frequencies ranging from 15-45%. The incidence rates of VAP are higher in developing countries with limited resources. Early and late VAP differ in their pathogenesis, micro-organisms responsible, antibiotic sensitivity, outcome and treatment.Methods: Retrospective cohort study of all critically ill children between 1 month to 12 years who were admitted and mechanically ventilated in our 8-bedded PICU between January 2015 to June 2016 and developed Ventilator associated pneumonia. PIM3 (Paediatric Index of Mortality 3) was calculated. We compared early and late VAP for risk factors, length of stay on mechanical ventilation (LOS MV) and outcome. The data collected were compiled and tabulated.Results: The incidence of VAP in this study was 40%. We found significant correlation between early and late VAP with parenteral nutrition (p = 0.001), presence of nasogastric tube (p = 0.012) and mortality (p = 0.027). The LOS MV was Mean 7.25 days in early VAP, while 22.75 days in late VAP; which demonstrated significant correlation (p = 0.003). There was no significant correlation of PIM3 with VAP, reintubation and mortality. Most frequent organisms found in Early VAP were Acinetobacter baumannii and MRSA, whereas in late VAP Pseudomonas aeruginosa was commonest isolated organism.Conclusions: VAP is a major cause of mortality in PICU. Late VAP was associated with longer length of stay on mechanical ventilation (LOS MV), higher mortality. This study thus emphasizes the need for prospective multicentric case-control studies for formulating and applying early preventive strategies in PICU to reduce VAP-related mortality.