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Ventilator‐associated pneumonia in a paediatric intensive care unit in a developing country with high HIV prevalence
Author(s) -
Morrow Brenda M,
Argent Andrew C
Publication year - 2009
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2008.01437.x
Subject(s) - medicine , interquartile range , pneumonia , incidence (geometry) , intensive care unit , ventilator associated pneumonia , bronchoalveolar lavage , population , comorbidity , lung , optics , physics , environmental health
Aim: To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator‐associated pneumonia (VAP). Methods: Non‐bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score ≥5. Results: A total of 230 patients aged 3.9 (2.2–9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty‐three patients (14.3%) were HIV‐exposed but uninfected and 58 (25.2%) were HIV‐infected. Of 172 BALs taken ≥48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae , viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P = 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non‐VAP patients. Median (IQR) length of PICU stay was 12.5 (5–21) days versus 8 (5–14) days ( P = 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 ( P = 0.002) in VAP versus non‐VAP patients, respectively. Conclusions: VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.