title: Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.
abstract: OBJECTIVE
  To determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Pediatric intensive care unit with 16 medical and surgical beds in a tertiary teaching hospital in Recife, northeast Brazil.
  
  
  METHODS
  Patients aged <18 yrs were consecutively enrolled between January 2005 and June 2006 into a cohort set to investigate health care-associated infections. Newborns and patients admitted for surveillance and those staying for <24 hrs were excluded. Patients were followed up daily throughout the stay and until 48 hrs after discharge from the unit.
  
  
  METHODS
  None.
  
  
  RESULTS
  This report focuses on health care-associated pneumonia, defined as pneumonia that occurs >48 hrs after admission but that was not incubating at the time of admission, as the primary outcome. Intrinsic and extrinsic variables were prospectively recorded into a standardized form. Statistical analyses, including multivariable logistic regression, were performed in Stata version 9.1. There were 765 eligible admissions. Health care-associated pneumonia occurred in 51 (6.7%) patients with an incidence density of 13.1 episodes/1,000 patient-days. There were 366 (47.8%) patients on mechanical ventilation, of whom 39 (10.7%) presented with ventilator-associated pneumonia with an incidence density of 27.1/1,000 days on ventilation. Longer stay on ventilation (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08), use of gastric tube (OR, 2.88; 95% CI, 1.41-5.87), and of sedatives/analgesics (OR, 2.45; 95% CI, 1.27-4.72) were identified as independent risk factors for healthcare-associated pneumonia.
  
  
  CONCLUSIONS
  Identification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.
authors.affiliation: Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, Pernambuco, Brazil.
authors.forename: Roberto J A
authors.initials: RJ
authors.lastname: Casado
authors.forename: Maria Júlia G
authors.initials: MJ
authors.lastname: de Mello
authors.forename: Rosana C F
authors.initials: RC
authors.lastname: de Aragão
authors.forename: Maria de Fátima P M
authors.initials: Mde F
authors.lastname: de Albuquerque
authors.forename: Jailson B
authors.initials: JB
authors.lastname: Correia
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control / Q000458:organization & administration*; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate