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PEDIATRICS Vol. 109 No. 5 May 2002, pp. 758-764

Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients: Risk Factors and Outcomes

Alexis M. Elward, MD, David K. Warren, MD and Victoria J. Fraser, MD

From the Division of Infectious Diseases, Departments of Pediatrics and Internal Medicine, Washington University School of Medicine, St Louis, Missouri

--> Objectives. To determine the rates, risk factors, and outcomes of ventilator-associated pneumonia in pediatric intensive care unit (PICU) patients.

Methods. A prospective cohort study was conducted at the St Louis Children’s Hospital PICU on all patients who were admitted to the PICU from September 1, 1999, to May 31, 2000, except those who died within 24 hours, were >=18 years of age, or were neonatal intensive care unit patients on extracorporeal membrane oxygenation. The primary outcome measured was the development of ventilator-associated pneumonia. Secondary outcomes were death and hospital and PICU length of stay. Multiple logistic regression analysis was performed to determine independent predictors for ventilator-associated pneumonia.

Results. There were 34 episodes of ventilator-associated pneumonia in 30 patients of 911 admissions (3.3%) and 595 (5.1%) mechanically ventilated patients. The mean ventilator-associated pneumonia rate was 11.6/1000 ventilator days. By logistic regression analysis, genetic syndrome (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.01–5.46), reintubation (OR: 2.71; 95% CI: 1.18–6.21), and transport out of the PICU (OR: 8.90; 95% CI: 3.82–20.74) independently predicted ventilator-associated pneumonia.

Conclusions. Ventilator-associated pneumonia occurs at significant rates among mechanically ventilated PICU patients and is associated with processes of care. Additional studies are necessary to develop interventions to prevent ventilator-associated pneumonia.

Key Words: ventilator-associated pneumonia • pediatric intensive care unit • nosocomial infection

Abbreviations: ICU, intensive care unit • PICU, pediatric intensive care unit • NNIS, National Nosocomial Infection Surveillance • SLCH, St Louis Children’s Hospital • PRISM, Pediatric Risk of Mortality Score • TPN, total perenteral nutrition

Received for publication Jan 3, 2001; Accepted Dec 12, 2001.


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