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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

doi: 10.1097/CCM.0b013e31821b840d
Pediatric Critical Care

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.

From the Instituto de Medicina Integral Prof. Fernando Figueira–IMIP (RJAC, MJGdM, RCFA, JBC), Recife, Pernambuco, Brazil; Faculdade Pernambucana de Saúde (MJGdeM), Recife, Brazil; Faculdade de Ciências Médicas, Universidade de Pernambuco (RCFA, JBC), Recife, Brazil; Fundação Oswaldo Cruz-FioCruz and Universidade Federal de Pernambuco (MdFPMA), Recife, Brazil.

Dr. Casado received financial support from the Instituto de Medicina Integral Prof Fernando, Figueira–IMIP.

This work was performed at Instituto de Medicina Integral.

The authors have not disclosed any potential conflicts of interest.

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