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Ventilator-Associated Pneumonia in Newborn Infants Diagnosed With an Invasive Bronchoalveolar Lavage Technique: A Prospective Observational Study*

Cernada, María MD1,2; Aguar, Marta MD2; Brugada, María MD1,2; Gutiérrez, Antonio MD2; López, José Luis MD3; Castell, Marta MD1; Vento, Máximo MD, PhD1,2

Pediatric Critical Care Medicine: January 2013 - Volume 14 - Issue 1 - p 55–61
doi: 10.1097/PCC.0b013e318253ca31
Neonatal Intensive Care

Objectives: To establish the incidence, etiology, risk factors, and outcomes associated with ventilator-associated pneumonia using an invasive sampling technique to avoid contamination.

Patients: Eligible patients were intubated neonates treated with mechanical ventilation who followed the criteria of the Centers for Disease Control and Prevention/National Nosocomial Infection Surveillance. Bronchoalveolar lavage samples were collected using a blind-protected catheter to avoid contamination of upper respiratory microorganisms. Isolation of >103 colony-forming unit/mL was required for diagnosis.

Measurements and Main Results: In 198 neonates intubated for >48 hrs, a total of 18 episodes of ventilator-associated pneumonia in 16 infants representing a prevalence of 8.1 were diagnosed. The pooled mean ventilator-associated pneumonia rate was 10.9/1,000 ventilator days. The mean age at diagnosis of ventilator-associated pneumonia was 29±15 days after a mean of 21±16 days of mechanical ventilation. Gram-negative bacteria were the most commonly isolated pathogens and Pseudomonas aeruginosa was the most frequent causative agent. Hospital length of stay was significantly longer for ventilator-associated pneumonia patients; however, no significant differences in mortality were found. Univariate analysis comparing patients with and without ventilator-associated pneumonia showed that days of mechanical ventilation, days of oxygen, number of reintubations, number of transfusions, bloodstream infection, and enteral feeding were all significantly associated with ventilator-associated pneumonia. However, in multivariate analysis the unique independent risk factor was days of mechanical ventilation (odds ratio 1.12, confidence interval 95% 1.07–1.17).

Conclusions: Ventilator-associated pneumonia is a frequent nosocomial infection in newborns. Only duration of mechanical ventilation has been identified as an independent risk factor for ventilator-associated pneumonia. The use of a blind invasive sampling technique seems to diminish sample contamination.

1 Health Research Institute Hospital La Fe, Valencia, Spain.

2 Division of Neonatology, University & Polytechnic Hospital La Fe, Valencia, Spain.

3 Division of Microbiology, University & Polytechnic Hospital La Fe, Valencia, Spain.

*See also p. 105.

Supported, in part, with a RD08/0072/0022 grant to Máximo Vento, MD, PhD, by the Institute Carlos III (Ministry of Science & Innovation; Spain).

The authors have not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies