title: Study of ventilator-associated pneumonia in a pediatric intensive care unit.
abstract: OBJECTIVE
  To determine the incidence, etiology, risk factors and outcome of ventilator associated pneumonia (VAP) among mechanically ventilated patients.
  
  
  METHODS
  All PICU patients who were mechanically ventilated for >48 h were consecutively enrolled. The development of VAP was defined by the radiological and clinical criteria described by the Center for Disease Control and Prevention/National Nosocomial Infection Surveillance (CDC/NNIS) (2003). The risk factors for VAP were determined by univariate and multivariate analysis using appropriate statistical methods.
  
  
  RESULTS
  The median age of the subjects (N = 232) was nine mo with a male to female ratio of 1.3:1. Of 232 subjects enrolled, there were 15 episodes of VAP in 14 patients (frequency of 6.03 %) with a mean VAP rate of 6.3/1,000 ventilator days. Eight of the 15 VAP episodes showed positive endotracheal culture with Gram negative organisms as the predominant isolate with Acinetobacter being the commonest organism isolated (62.5 %). Neuromuscular disease (P = 0.005), histamine-2 receptor blockers (P = 0.0001), tracheostomy (P = 0.0001), and positive blood culture growth (P = 0.0008) were found to be significantly associated with VAP (univariate analysis). VAP patients had a significantly longer duration of mechanical ventilation (22.5 vs. 5 median days; P < 0.001), longer PICU stay (23.25 vs. 6.5 median days; P < 0.001) and longer hospital stay (43.75 vs. 13.25 median days; P < 0.001). On multivariate analysis, only positive blood culture growth was a risk factor for VAP. The mortality rate of VAP was 42.8 % (not higher than those without VAP).
  
  
  CONCLUSIONS
  Frequency of VAP was 6.03 % with neuromuscular disease, histamine-2 receptor blockers, tracheostomy and positive blood culture being risk factors for VAP.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Balasubramanian
authors.forename: Milind S
authors.initials: MS
authors.lastname: Tullu
mesh_terms: D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors