title: Nosocomial pneumonia in the pediatric trauma patient: a single center's experience.
abstract: OBJECTIVE
  To evaluate a single center's experience with the frequency rate, patterns of occurrence, and impact on outcome of nosocomial pneumonia in the critically injured child.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  Level I university trauma center with a pediatric trauma intensive care unit.
  
  
  METHODS
  A total of 523 consecutive critically injured children admitted to the pediatric intensive care unit during an 80-month interval.
  
  
  RESULTS
  Thirty-five episodes of nosocomial pneumonia were identified in 29 children (frequency rate of 5.5%). The mean age of the children was 9.2 yrs, and the mean Injury Severity Score was 27 +/- 9. In 91% of patients (26 children), nosocomial pneumonia was associated with mechanical ventilation. This represented a 13% frequency rate in injured children who were ventilated during the study period. The most common organisms recovered were Staphylococcus aureus (21%), Haemophilus influenzae (19%), Pseudomonas (11%), and Enterobacter (11%). Early pneumonia (diagnosed < or = 7 days after injury) was predominantly caused by Haemophilus species. In contrast, Enterobacter and/or Pseudomonas were isolated primarily in late pneumonia (diagnosed >7 days after injury). Staphylococcus was prominent throughout the hospitalization. Overall, children with nosocomial pneumonia were more severely injured (Injury Severity Score 27 vs. 17, p < .001) and had a longer hospital stay (26 vs. 7 days, p < .001). Despite this, mortality (6.9% vs. 7.9%, p = NS) was not significantly different from injured children without pneumonia.
  
  
  CONCLUSIONS
  In this study of a single pediatric trauma center, nosocomial pneumonia occurred in a small but significant percentage of injured children. The frequency rate increased two- to three-fold with mechanical ventilation. Microbiology varied with day of onset. In contrast to the adult, mortality did not seem to be significantly altered by this complication. Analysis of additional pediatric trauma centers is encouraged to confirm these characteristics of nosocomial pneumonia in the injured child.
authors.affiliation: Department of Surgery, University of Florida, Health Science Center Jacksonville, 32209-6511, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Patel
authors.forename: D L
authors.initials: DL
authors.lastname: Mollitt
authors.forename: P
authors.initials: P
authors.lastname: Pieper
authors.forename: J J
authors.initials: JJ
authors.lastname: Tepas
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009104:Multiple Trauma / Q000150:complications*; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers