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Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit in Saudi Arabia: A 30-Month Prospective Surveillance

Published online by Cambridge University Press:  02 January 2015

Maha Almuneef ,
Ziad A. Memish ,
Hanan H. Balkhy ,
Hala Alalem  and
Abdulrahman Abutaleb
Maha Almuneef
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ziad A. Memish*
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Hanan H. Balkhy
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Hala Alalem
Affiliation:
Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Abdulrahman Abutaleb
Affiliation:
Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
*
Infectious Diseases Division, Department of Medicine, and Executive Director, Infection Prevention & Control Program, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 22490, Riyadh 11426, Saudi Arabia
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Abstract

Objective:

To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients.

Methods:

This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions.

Results:

Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP.

Conclusions:

The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 9 , September 2004 , pp. 753 - 758
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Elward, AM. Pediatric ventilator-associated pneumonia. Pediatr Infect Dis J 2003;22:445–446.Google Scholar
2.Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR 1997;46():1–79.Google Scholar
3.Urrea, M, Pons, M, Serra, M, Latorre, C, Palomeque, A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003;22:490–493.Google Scholar
4.Raymond, J, Aujard, Y. Nosocomial infection in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21:260–263.Google Scholar
5.Stover, BH, Shulman, ST, Bratcher, DF, Brady, MT, Levine, GL, Jarvis, WR. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001;29:152–157.Google Scholar
6.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
7.Khuri-Bulos, N, Shennak, M, Agabi, S, et al.Nosocomial infections in the intensive care units at a university hospital in a developing country: comparison with National Nosocomial Infections Surveillance intensive care unit rates. Am J Infect Control 1999;27:547–552.Google Scholar
8.Memish, ZA, Cunningham, G, Oni, GA, Djazmati, W. The incidence and risk factors of ventilator-associated pneumonia in a Riyadh hospital. Infect Control Hosp Epidemiol 2000;21:271–273.Google Scholar
9.Citak, A, Karabocuoglu, M, Ucsel, R, Uger-Baysal, S, Uzel, N. Bacterial nosocomial infections in mechanically ventilated children. Turk J Pediatr 2000;42:39–42.Google Scholar
10.Kanafani, ZA, Kara, L, Hayek, S, Kanj, SS. Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol 2003;24:864–869.Google Scholar
11.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
12.Elward, AM, Warren, DK, Fraser, VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 2002;109:758–764.Google Scholar
13.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in pediatric intensive care units in the United States. Pediatrics 1999;103:e39.Google Scholar
14.Bauer, TT, Ferrer, R, Angrill, J, Schultze-Werninghaus, G, Torres, A. Ventilator-associated pneumonia: incidence, risk factors, and microbiology. Semin Respir Infect 2000;15:272–279.CrossRefGoogle ScholarPubMed
15.Epps, B, Edwards, JR, Sohn, AH, Horan, TC, Gaynes, RP. Improving benchmarks for surveillance by defining types of pediatric intensive care units. Am J Infect Control 2002;30:68–70.Google ScholarPubMed
16.Beck-Sague, CM, Sinkowitz, RL, Chinn, RY, Vergo, J, Kaler, W, Jarvis, WR. Risk factors for ventilator-associated pneumonia in surgical intensive-care-unit patients. Infect Control Hosp Epidemiol 1996;17:374–376.Google Scholar
17.Memish, ZA, Oni, GA, Djazmati, W, Cunningham, G, Mah, MW. A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia. Am J Infect Control 2001;29:301–305.Google Scholar
18.Cook, D, De Jonghe, B, Brochard, L, Brun-Buisson, C. Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials. JAMA 1998;279:781–787.Google Scholar
19.Valles, J, Artigas, A, Relio, J, et al.Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–186.Google Scholar
20.Yildizdas, D, Yapicioglu, H, Yilmaz, HL. Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care 2002;17:240–245.Google Scholar
21.Lopriore, E, Markhorst, DG, Gemke, RJ. Ventilator-associated pneumonia and upper airway colonisation with gram negative bacilli: the role of stress ulcer prophylaxis in children. Intensive Care Med 2002;28:763–767.Google Scholar
22.Bonten, MJ, Weinstein, RA. Infection control in intensive care units and prevention of ventilator-associated pneumonia. Semin Respir Infect 2000;15:327–335.Google Scholar
23.Gruson, D, Hilbert, G, Vargas, F, et al.Strategy of antibiotic rotation: long-term effect on incidence and susceptibilities of gram-negative bacilli responsible for ventilator-associated pneumonia. Crit Care Med 2003;31:1908–1914.Google Scholar
24.Kirschke, DL, Jones, TF, Craig, AS, et al. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med 2003;348:214–220.CrossRefGoogle ScholarPubMed
25.Srinivasan, A, Wolfenden, LL, Song, X, et al.An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med 2003;348:221–227.Google Scholar
26.Johnson, KL, Kearney, PA, Johnson, SB, Niblett, JB, MacMillan, NL, McClain, RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 1994;22:658–666.Google Scholar
27.Mayhall, CG. The Trach Care closed tracheal suction system: a new medical device to permit tracheal suctioning without interruption of ventilatory assistance. Infect Control Hosp Epidemiol 1988;9:125–126.Google Scholar