Background and Aims Ventilator-associated pneumonia (VAP) may complicate the hospital course in critically ill children with pneumonia or bronchiolitis admitted to PICU. We compared the outcomes and treatment in PICU patients with pneumonia or bronchiolitis who developed VAP and those without VAP.
Methods The medical records of PICU patients with pneumonia or bronchiolitis from January 2011 to December 2011 in a tertiary care hospital were reviewed. Demographic and clinical data including antibiotic therapy were recorded.VAP was diagnosed according to CDC criteria.
Results 28 patients were recruited, 12(42%) with VAP and 14(58%) without VAP, mean age 3.7±1.1 and 3.6±4.7, respectively. PRISM III score at admission, comorbidity (chronic lung disease, cardiopathy, mental retardation, malnutrition or obesity, immunosuppression),antacid medication and systemic steroid use were similar in both groups. The most common VAP pathogens were gram(-) bacteria (Acinetobacter baumannii and Pseudomonas aeruginosa). Antibiotics use in the 2 groups are shown in figure 1.
Patients with VAP received longer treatment with aminoglucisides compared with patients without VAP (18.42±13.02 vs. 6.25±5.19 days, P<0.01). Moreover, only children with VAP were treated with quinolones. Patients with VAP had also significantly increased length of PICU stay(LOS) and mechanical ventilation. (figure 2).
Conclusions VAP occurs in a significant proportion of PICU patients with lower respiratory infection resulting in increased LOS and antibiotic use.