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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

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Abstract

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

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