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Ventilator-Associated Pneumonia and Events in Pediatric Intensive Care

A Single Center Study

Chomton, Maryline, MD1; Brossier, David, PhD2; Sauthier, Michaël, MD3; Vallières, Emilie, PhD4; Dubois, Josée, PhD5; Emeriaud, Guillaume, PhD3; Jouvet, Philippe, PhD3

doi: 10.1097/PCC.0000000000001720
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Objectives: Ventilator-associated pneumonia is the second most common nosocomial infection in pediatric intensive care. The Centers for Disease Control and Prevention recently issued diagnosis criteria for pediatric ventilator-associated pneumonia and for ventilator-associated events in adults. The objectives of this pediatric study were to determine the prevalence of ventilator-associated pneumonia using these new Centers for Disease Control and Prevention criteria, to describe the risk factors and management of ventilator-associated pneumonia, and to assess a simpler method to detect ventilator-associated pneumonia with ventilator-associated event in critically ill children.

Design: Retrospective, observational, single-center.

Setting: PICU in a tertiary-care university hospital.

Patients: Consecutive critically ill children mechanically ventilated for greater than or equal to 48 hours between November 2013 and November 2015.

Interventions: None.

Measurements and Main Results: Of 304 patients mechanically ventilated for greater than or equal to 48 hours, 284 were included. Among them, 30 (10.6%) met clinical and radiologic Centers for Disease Control and Prevention criteria for ventilator-associated pneumonia, yielding an prevalence of 7/1,000 mechanical ventilation days. Median time from mechanical ventilation onset to ventilator-associated pneumonia diagnosis was 4 days. Semiquantitative culture of tracheal aspirates was the most common microbiological technique. Gram-negative bacteria were found in 60% of patients, with a predominance of Haemophilus influenzae and Pseudomonas aeruginosa. Antibiotic therapy complied with adult guidelines. Compared with patients without ventilator-associated pneumonia, those with ventilator-associated pneumonia had significantly longer median durations of mechanical ventilation (15 vs 6 d; p < 0.001) and PICU stay (19 vs 9 d; p < 0.001). By univariate analysis, risk factors for ventilator-associated pneumonia were younger age, reintubation, acute respiratory distress syndrome, and continuous enteral feeding. Among the 30 patients with ventilator-associated pneumonia, 17 met adult ventilator-associated event’s criteria (sensitivity, 56%).

Conclusions: Ventilator-associated pneumonia is associated with longer times on mechanical ventilation and in the PICU. Using the ventilator-associated event criteria is of interest to rapidly screen for ventilator-associated pneumonia in children. However, sensitivity must be improved by adapting these criteria to children.

1Pediatric Intensive Care Unit, Robert Debré University Hospital Center, Paris, France.

2Pediatric Intensive Care Unit, University Hospital, Caen, France.

3Pediatric Intensive Care Unit, Sainte-Justine University Hospital Center, Montreal, QC, Canada.

4Department of Microbiology and Immunology, Sainte-Justine University Hospital Center, Montreal, QC, Canada.

5Department of Medical Imaging, Sainte-Justine University Hospital Center, Montreal, QC, Canada.

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Dr. Emeriaud’s institution received funding from a clinical research scholarship of the Fonds de Recherche du Quebec – Sante. Dr. Jouvet’s institution received funding from Air Liquide Sante, Covidien, and Medunik, and he disclosed that medical devices were lent by Hamilton Medical, Philips, and Maquet. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies