Ventilator-Associated Pneumonia in Neonatal Patients: An Update

Cernada, María; Brugada, María; Golombek, Sergio; Vento, Máximo

doi:10.1159/000355539

Cited by 115 publications

(139 citation statements)

References 128 publications

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“…A total of 15 mechanically ventilated neonates with VAP at the Children's Hospital of Chongqing Medical University (Chongqing, China) were included in the present study. VAP was diagnosed according to the accepted VAP criterion defined by the Centers for Disease Control and Prevention of America (19,20). Of the 15 intubated neonates with VAP included in the present study, 8 (53.3%) were male and 7 (46.7%) were female ( Table I).…”

Section: Methodsmentioning

confidence: 99%

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Pan

Ai³

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Ventilator-associated pneumonia (VAP) is a common nosocomial infection in neonatal intensive care units with high morbidity and mortality. Bacterial biofilm in the endotracheal tube (ET) provides a notable and persistent source of pathogens that may cause VAP, and thus is important for VAP detection. However, during intubation microbial investigations in ET, samples are unavailable due to the infeasibility of collecting ET samples during intubation of neonates. It is therefore of great importance to find alternative sources of samples that can help identify the ET biofilm flora. In the present study, the microbial signatures of throat swabs and tracheal aspirates were compared with ET biofilm samples from VAP neonates using 16S ribosomal RNA gene polymerase chain reaction, denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Sequences were assigned to phylogenetic species using BLAST. Microbial diversity and richness among the three types of specimens were compared based on their DGGE fingerprints, and taxonomic characteristics based on the BLAST results. The microbial richness and diversity of ET biofilms were similar to tracheal aspirate yet significantly different from throat swab samples (P<0.05). Compared with ET biofilms, the overall constituent ratio of microflora was significantly different in throat swab and tracheal aspirate samples (P<0.05). However tracheal aspirate samples were useful for predicting Staphylococcus sp. in ET biofilms with a sensitivity of 85.7% and a specificity of 83.3%. The sensitivity for the combination of tracheal aspirate and throat swab samples to detect Staphylococcus sp. in ET biofilms was 100%. The detection of Pseudomonas sp. in throat swabs assisted its identification in ET biofilms (sensitivity 33.3% and specificity 100%). The results of the present study suggest that microbial investigations in throat swab and tracheal aspirate samples are beneficial for identifying the ET biofilm flora. There may therefore be clinical applications of using substituent samples to identify pathogens in ET biofilms for VAP surveillance among intubated neonates.

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Section: Methodsmentioning

confidence: 99%

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Pan

Ai³

et al. 2017

Experimental and Therapeutic Medicine

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“…The use of the closed suction system has had low evidence in reducing PAV over the other technique of vacuum, with the system off [4,30]. The preference for periodic aspiration of the upper airways over the lower airways [8.10, 13.16] was justified by the fact that the accumulation of secretions in the oropharynx favors the colonization of microorganisms and the occurrence of microaspirations.…”

Section: Brazil 2015mentioning

confidence: 99%

“…In neonates, it can be associated with the following risk factors: endotracheal reintubation, enteral nutrition, low birth weight and prematurity. In pediatric patients, it can be associated with endotracheal reintubation, use of the immunosuppressant drug and previous use of antibiotics [3][4]. The most common microorganisms isolated in PAV in neonatal units are Pseudomonas aeruginosin; Staphylococcus aureus, Klebsiella pneumonia and Escherichia coli [5].…”

Section: Introductionmentioning

confidence: 99%

Bundle Method In Reducing Pneumonia Associated With Mechanical Ventilation In Newborns And Children: Integrative Review

França¹,

Cassiano

Vitorino

et al. 2016

Int Arch Med

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Infections related to health care are a public health problem, given the repercussions of the event to the morbidity and mortality of the population and having health spending. Pneumonia Associated to Mechanical Ventilation has the incidence of 8.1% to 57.1% in neonates and 23% in children. This study is an integrative literature review aimed to check the scientific production concerning the use of bundle guidelines to reduce of PAV in children and newborns in intensive care units and analyze the results of these research. For data collection, the keyword bundle, and the descriptors infant, newborn; Intensive Care Units, Neonatal Pneumonia, Ventilator-Associated and Child(ren) for online search in databases: PUBMED, SCOPUS, LILACS and CINHAL. The initial result of the search was 891 articles and after application of inclusion and exclusion criteria, the sample resulted in nine articles. This study points out that in general VAP prevention measures found in bundles were effective in reducing PAV rates in neonates and pediatric patients. However, there are still differences in the development of some interventions, especially for newborns. It is necessary to develop other studies, including the better level of evidence to address the use of bundle for PAV prevention of these population, considered more vulnerable to incidents related to health care.

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“…7 According to data published by the National Nosocomial Infection Surveillance System (NNIS) program sponsored by the Centre for Disease Control and Prevention (CDC), VAP rates in PICU oscillate from 1.4 to 7 episodes per 1,000 ventilator days. [8][9][10] Incidence of paediatric VAP as mentioned in western literature varies from 5.1% to 33%. 5,9,11 However, in developing countries the reported rates are significantly higher, ranging from 16.1 to 89 episodes per 1,000 ventilator days.…”

Section: Introductionmentioning

confidence: 99%

“…8 Moreover, pathogens can reach the lung from exogenous sources such as hands of healthcare workers, ventilator circuits, and the biofilm of endotracheal tube. 17 As children differ greatly from adults in their anatomy, physiology and underlying disease, specific aetiology for VAP in them is described.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

Malhotra

Kumar

Thapar

et al. 2018

Int J Contemp Pediatr

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Background: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection in the paediatric intensive care unit (PICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate, risk factors and bacteriological profile and outcome of early and late ventilator associated pneumonia in PICU.Methods: The study was conducted from December 2015 to November 2017 in which 89 children beyond 1 year of age were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. The endotracheal secretions were collected, processed and recorded as per standard microbiological methods. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP.Results: Of all the mechanically ventilated patients, 33.7% developed VAP. Incidence of Early VAP was 23.3% and that of Late VAP was 76.67%. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Micro-organisms identified by culture, involved in the aetiology of VAP were: gram-negative bacteria in 74.9% and gram-positive bacteria in 25.1%. The overall mortality rate was 43.33%.Conclusions: Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Overall the most common Gram-negative bacteria associated with VAP was Acinetobacter baumanii. The most common isolate in early VAP was Acinetobacter baumanii whereas infections by Pseudomonas and E. coli are common in late VAP. population.

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Ventilator-Associated Pneumonia in Neonatal Patients: An Update

Cited by 115 publications

References 128 publications

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Microbial investigations in throat swab and tracheal aspirate specimens are beneficial to predict the corresponding endotracheal tube biofilm flora among intubated neonates with ventilator-associated pneumonia

Bundle Method In Reducing Pneumonia Associated With Mechanical Ventilation In Newborns And Children: Integrative Review

Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

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