title: Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric ICU.
abstract: BACKGROUND
  Adult studies have demonstrated that ventilator-associated tracheobronchitis (VAT) may be a precursor to ventilator-associated pneumonia (VAP). No published data on VAT in pediatric ICUs (PICUs) were found. The purposes of this retrospective, descriptive study are to describe the incidence, characteristics, and outcomes of patients at risk for VAT and formalize a process of VAT surveillance in the PICU population.
  
  
  METHODS
  All patients meeting criteria for VAT during 2009-2010 were reviewed and data collected on risk of mortality, index of mortality, interventions, demographic data, respiratory cultures, and the organisms identified in culture.
  
  
  RESULTS
  Of 645 patients (32.7%) admitted who met mechanical ventilation criteria, 22 (3.4%) met criteria for VAT. Patients with VAT experienced a significantly longer mean length of stay in the PICU (27.6±22.043 days vs 6.61±7.27 days; P=.000) and higher mean total ventilator time (519.31±457.60 h vs 95.60±138.83 h; P=.000). There was a significant association between tracheostomy and VAT (P=.000) and between chronic ventilator dependence and VAT (P=.002). Gram-negative rods accounted for 71% of cultured microorganisms; staphylococcal or streptococcal species were identified as 26% of causative pathogens. Six of 25 (24%) VAT events identified two or more potentially causative pathogens; four of these (67%) were in patients with a tracheostomy.
  
  
  CONCLUSIONS
  VAT occurred less frequently in our PICU than reported in adult studies, and no cases of VAT progressed to VAP in our population. Our results suggest that VAT is a clinically significant health-care-associated infection in the PICU population.
authors.affiliation: Dell Children's Medical Center of Central Texas, Dell Children's Medical Center of Central Texas, Austin, TX.
authors.forename: Vickie S
authors.initials: VS
authors.lastname: Simpson
authors.affiliation: Dell Children's Medical Center of Central Texas, Dell Children's Medical Center of Central Texas, Austin, TX.
authors.forename: Ann
authors.initials: A
authors.lastname: Bailey
authors.affiliation: Pediatric Intensive Care Unit, Dell Children's Medical Center of Central Texas, Austin, TX.
authors.forename: Renee A
authors.initials: RA
authors.lastname: Higgerson
authors.affiliation: Pediatric Critical Care, Dell Children's Medical Center of Central Texas, Austin, TX. Electronic address: lchristie@seton.org.
authors.forename: LeeAnn M
authors.initials: LM
authors.lastname: Christie
mesh_terms: D001991:Bronchitis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D015996:Survival Rate; D014139:Tracheostomy / Q000009:adverse effects