Incidence, risk factors, microbiological profile and outcome of ventilator-associated pneumonia in paediatric intensive care unit

Objectives This study aims to assess the incidence, risk factors and outcomes associated with ventilator-associated pneumonia (VAP) in PICU patients as well as analyse the microbiological characteristics of VAP. Material and Methods A 20-month prospective observational study was conducted in the PICU of a tertiary hospital. The study included all children requiring mechanical ventilation (MV) for more than 48 hrs, until 100 patients were enrolled. Information on demographics, clinical features, laboratory findings, imaging, treatment and outcomes was documented. VAP was diagnosed using centers of disease control/national nosocomial infections surveillance (CDC/NNIS) criteria and confirmed through endotracheal (ET) aspirate cultures (≥105 colony forming unit (CFU)/mL). Patients with VAP were compared to those without regarding risk factors, clinical details, treatment and outcomes, including length of stay and mortality. All participants were followed until discharge or death. Results VAP incidence was 51% based on CDC/NNIS criteria, with microbiological confirmation in 41% of cases. Nearly half of the cases were early-onset VAP, and the incidence density was 57.4 episodes/1000 ventilator days. Younger children (≤1 year) were disproportionately affected (60.8%). Gender had no significant impact on VAP development. Respiratory conditions were the most common predisposing factors, though primary diagnoses did not significantly affect VAP rates. Risk factors such as nasogastric feeding during MV, prior antibiotic use, proton pump inhibitors and uncuffed ET tubes were significantly associated with VAP ( P < 0.01). The VAP-associated mortality rate was 33.3%, similar to the 18.4% mortality in nonVAP pneumonia. Most VAP-related deaths were linked to Gram-negative bacteria, primarily Acinetobacter, Klebsiella and Escherichia coli . The VAP group had significantly longer PICU and hospital stays compared to the non-VAP group. Conclusions VAP is a frequent and serious complication in mechanically ventilated PICU patients, significantly increasing the duration of hospitalisation and intensive care unit (ICU) stays. While it does not markedly raise mortality rates compared to non-VAP pneumonia, it emphasises the need for better prevention, early diagnosis and management strategies in the PICU setting.