title: Ventilator-associated pneumonia in a tertiary paediatric intensive care unit: a 1-year prospective observational study.
abstract: OBJECTIVE
  To determine the incidence, risk factors and impact of ventilator-associated pneumonia (VAP) in a mixed tertiary paediatric intensive care unit.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Patients in the intensive care unit who were mechanically ventilated for more than 48 hours were assessed daily, according to criteria for a diagnosis of VAP. Potential risk factors for VAP, if present, were documented.
  
  
  RESULTS
  Of 692 invasively ventilated patients, 269 (38.9%) were ventilated for > 48 hours and met no exclusion criteria. Eighteen (6.7%) patients had episodes of VAP, and the VAP incidence density was 7.02 per 1000 intubation days. The mean admission Paediatric Index of Mortality 2 risk of death was similar in patients with and without VAP (0.084 v 0.056; P =0.8). Patients with VAP (compared with patients without VAP) had a longer median duration of ICU stay, (19.35 v 7.35 days; P < 0.001), duration of ventilation (11.99 v 4.92 days; P=0.024) and duration of hospital stay (35.5 v 20 days; P < 0.001). Univariate analysis showed that reintubation, absence of tube feeding and absence of stress ulcer prophylaxis were risk factors for VAP. While backward selection removed reintubation as a positive predictor during multivariate analysis, tube feeds (hazard ratio (HR), 0.27; 95% CI, 0.09-0.85; P = 0.02) and stress ulcer prophylaxis (HR, 0.29; 95% CI, 0.11-0.76; P = 0.01) were independently associated with reduced VAP incidence.
  
  
  CONCLUSIONS
  VAP in children is associated with significant morbidity and increased length of hospital stay. Enteral feeding and stress ulcer prophylaxis while intubated are associated with lower VAP hazards.
authors.affiliation: The Children's Hospital at Westmead, Sydney, NSW, Australia. anilgautam2005@rediffmail.com
authors.forename: Anil
authors.initials: A
authors.lastname: Gautam
authors.forename: Subodh S
authors.initials: SS
authors.lastname: Ganu
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Tegg
authors.forename: David N
authors.initials: DN
authors.lastname: Andresen
authors.forename: Barry H
authors.initials: BH
authors.lastname: Wilkins
authors.forename: David N
authors.initials: DN
authors.lastname: Schell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors