Profile of Ventilator Associated Pneumonia in Children Admitted to Pediatric Intensive Care Unit of a Tertiary Care Center in India

Abstract

Introduction: Limited literature is available on VAP in children, particularly from India.Hence this study aims to determine the incidence, clinical, laboratory, radiological and microbiological profile, risk factors, and outcomes of ventilator-associated pneumonia in pediatric patients.

Methods: This is a prospective observational study which enrolled 125 children who were mechanically ventilated in the PICU of a tertiary teaching care hospital over a period of 2 years. Demographic, clinical, radiological and laboratory details were collected and CPIS was used to diagnose VAP. Endo tracheal aspirates were obtained at 48hrs and 96 hrs of initiation of mechanical ventilation and were cultured as per standard guidelines. All the demographic, clinical, radiological and micro biological details were entered in SPSS version 17.0.Standard statistical tests were used to analyze data.

Results: Among the 125 ventilated children, 44 were found to have VAP as per the CPIS showing its incidence of 35.2%. In our study incidence of early VAP is 27.6% while that of late VAP is 75%. The major risk factor for the incidence of VAP in this study was the duration of ventilation. VAP occurred in 75% of patients intubated for more than 5 days. Among 63 children who were reintubated, 34(53.9%) developed VAP while the incidence of VAP was only 16.1% among those who were not reintubated (p value- 0.016). In this study out of the microorganisms isolated in patients with early VAP, 45% were Acinetobacter species, 20% Klebsiella pneumoniae and 10% Pseudomonas aeruginosa. Whereas in late onset VAP, Acinetobacter constituted 60% of all microbes while the rest comprised of Pseudomonas aeruginosa (20%) and Klebsiella pneumonia (6.6%).

Conclusions: Significant risk factors in development of VAP were reintubation and duration of ventilation. The most common VAP pathogen was Acinetobacter species.Tracheostomized children have higher incidence of VAP but have higher recovery rates.