Critical Care Medicine

Skip Navigation LinksHome > August 2011 - Volume 39 - Issue 8 > Incidence and risk factors for health care-associated pneumo...
Critical Care Medicine:
doi: 10.1097/CCM.0b013e31821b840d
Pediatric Critical Care

Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit*

Casado, Roberto J. A. MD, MSc; de Mello, Maria Júlia G. MD, PhD; de Aragão, Rosana C. F. MD, MSc; de Albuquerque, Maria de Fátima P. M. MD, PhD; Correia, Jailson B. MD, PhD

Collapse Box


Objectives: To determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.

Design: Prospective cohort study.

Setting: Pediatric intensive care unit with 16 medical and surgical beds in a tertiary teaching hospital in Recife, northeast Brazil.

Patients: Patients aged <18 yrs were consecutively enrolled between January 2005 and June 2006 into a cohort set to investigate health care-associated infections. Newborns and patients admitted for surveillance and those staying for <24 hrs were excluded. Patients were followed up daily throughout the stay and until 48 hrs after discharge from the unit.

Interventions: None.

Measurements and Main Results: This report focuses on health care-associated pneumonia, defined as pneumonia that occurs >48 hrs after admission but that was not incubating at the time of admission, as the primary outcome. Intrinsic and extrinsic variables were prospectively recorded into a standardized form. Statistical analyses, including multivariable logistic regression, were performed in Stata version 9.1. There were 765 eligible admissions. Health care-associated pneumonia occurred in 51 (6.7%) patients with an incidence density of 13.1 episodes/1,000 patient-days. There were 366 (47.8%) patients on mechanical ventilation, of whom 39 (10.7%) presented with ventilator-associated pneumonia with an incidence density of 27.1/1,000 days on ventilation. Longer stay on ventilation (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.08), use of gastric tube (OR, 2.88; 95% CI, 1.41–5.87), and of sedatives/analgesics (OR, 2.45; 95% CI, 1.27–4.72) were identified as independent risk factors for healthcare-associated pneumonia.

Conclusion: Identification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.