title: Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia.
abstract: BACKGROUND
  Prevention of ventilator-associated pneumonia (VAP) is a major patient safety goal, but accurate identification of VAP in pediatric patients remains challenging.
  
  
  METHODS
  We performed a retrospective cohort study to demonstrate feasibility of endotracheal culture and Gram's stain to support VAP diagnosis. Pediatric intensive care unit and cardiac intensive care unit patients with ≥ 1 endotracheal specimen having growth of ≥ 1 organism in conjunction with moderate/many polymorphonuclear leukocytes (ie, the modified microbiologic criterion) were included. Medical records were reviewed for presence/absence of clinical and radiographic Centers for Disease Control and Prevention (CDC) criteria for VAP. Antimicrobial use data were collected before and after culture results were known.
  
  
  RESULTS
  Of 102 patients meeting inclusion criteria, 28% (n = 28) also met both clinical and radiographic CDC criteria for VAP (ie, diagnosis of PNU2). An additional 63% (n = 64) met clinical (36%; n = 37) or radiographic (27%; n = 27) criteria, but not both. Ten patients (9%) had neither clinical nor radiographic criteria for VAP. The majority (63%; n = 64) were receiving antibiotics at time of endotracheal specimen collection. Culture identification resulted in altered antimicrobial therapy in 66% of patients (n = 67).
  
  
  CONCLUSIONS
  Our study demonstrates the feasibility of endotracheal Gram's stain and culture for diagnosis of pediatric VAP that could potentially standardize accurate surveillance and management of pediatric VAP.
authors.affiliation: Division of Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC.
authors.forename: Paulina
authors.initials: P
authors.lastname: Mariki
authors.affiliation: Division of Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC.
authors.forename: Neil
authors.initials: N
authors.lastname: Rellosa
authors.affiliation: Division of Pediatric Critical Care, Children's National Medical Center, Washington, DC.
authors.forename: Angela
authors.initials: A
authors.lastname: Wratney
authors.affiliation: Division of Pediatric Critical Care, Children's National Medical Center, Washington, DC.
authors.forename: David
authors.initials: D
authors.lastname: Stockwell
authors.affiliation: Division of Pediatric Critical Care, Children's National Medical Center, Washington, DC.
authors.forename: John
authors.initials: J
authors.lastname: Berger
authors.affiliation: Division of Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Song
authors.affiliation: Division of Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: rdebiasi@childrensnational.org.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: DeBiasi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D012189:Retrospective Studies; D014132:Trachea / Q000382:microbiology*
keywords: Endotracheal cultures; Hospital-acquired infection; VAP