meray labib

Citation:

Galal, Y. S., meraY rene l. YouSSef, and S. Y. K. ibrahiem, Ventilator-Associated Pneumonia:, , 2016.

Abstract:

Introduction: Ventilator-Associated Pneumonia (VAP) is a major
cause of hospital morbidity, mortality and increased health care
costs. Although the epidemiology, pathogenesis and outcome
of VAP are well described in adults; few data exist regarding
VAP in paediatric patients, especially in developing countries.
Aim: To determine the incidence, risk factors and outcome of
VAP in two Paediatric Intensive Care Units (PICUs) at Cairo
University Hospital.
Materials and Methods: A total of 427 patients who received
Mechanical Ventilation (MV) were included in this prospective
study during the period from September 2014 till September
2015. Patients were observed daily till VAP occurrence, discharge
from the unit or death, whichever came first. Demographic,
clinical characteristics, laboratory results, radiographic and
microbiological reports were recorded for all patients.
results: Nearly 31% patients developed VAP among the entire
cohort.The incidence density was 21.3 per 1000 ventilator days.
The most frequently isolated organisms from VAP patients were
Pseudomonas aeruginosa (47.7%), Acinetobacter (18.2%) and
Methicillin-resistant Staphylococcus aureus (MRSA) (14.4%).
VAP patients were significantly younger than non-VAP ones. The
incidence of VAP in comatose patients and those with MOSF
was significantly higher. Prior antibiotic use for > 48 h before
MV, supine body positioning and reintubation were significantly
associated with VAP. On multiple logistic regression analysis,
MOSF; prior antibiotic use > 48h; reintubation; coma; and age
remained independent predictors of VAP. Mortality rate among
the VAP group was significantly higher compared to the nonVAP one (68.2% vs. 48.5%, p<0.001). Survival curve analysis
showed a shorter median survival time in VAP patients.
conclusion: Identification of risk factors and outcome of VAP
in PICUs may help in reducing the incidence and improving
patients’ outcomes. The incidence of VAP in this study was
relatively high.The most prominent risk factors for occurrence
of VAP were MOSF, prior antibiotic use for > 48 h before MV,
reintubation, coma and age. Proper use of antibiotics before
MV in PICUs is essential. Also, adequate training of nurses and
strict supervision of infection control protocols are crucial. Lack
of a gold standard for the diagnosis of VAP and difficulty in
sampling procedures were among the study limitations.