Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients.
Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.
Foglia
Elizabeth
E
Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, Box 8116, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA.
Meier
Mary Dawn
MD
Elward
Alexis
A
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003428:Cross Infection / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D020969:Disease Attributes; D006635:Histamine H2 Antagonists / Q000008:administration & dosage; D006801:Humans; D006920:Hygiene; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011159:Population Surveillance; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D018571:Sentinel Surveillance; D013392:Sucralfate / Q000008:administration & dosage; D014481:United States
D000890:Anti-Infective Agents; D006635:Histamine H2 Antagonists; D013392:Sucralfate