Ventilator-Associated Pneumonia in Neonates Admitted to a Tertiary Care NICU in Bulgaria

Abstract

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection (HAI) among neonatal patients in the intensive care units (ICUs) and is a serious challenge for neonatologists because it affects critically ill patients who need prolonged mechanical ventilation. In Bulgaria, there is no detailed data at regional and national levels on the characteristics of VAP in newborns, which imposes a necessity for specific studies of risk factors and etiology of VAP. The aim of the study was to analyze the frequency, characteristics and risk factors for the occurrence of VAP in newborns hospitalized in intensive care unit. This was a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. The sample consisted of 507 neonates, followed up prospectively, 107 of whom were placed on mechanical ventilation for ≥48 h. VAP was diagnosed in 33 out of 107 neonates (31%). The VAP incidence rate was 35.06/1.000 ventilator days. We confirmed differences between the median birth weight (1,310 vs. 1,690 g, p = 0.045) and average gestational age (31.08 g.w. vs. 33.08 g.w, p = 0.04) of the patients with and without VAP. The average stay of patients with VAP in the NICU was statistically significantly longer than the hospital stay of non-VAP patients (35.70 ± 21.84 days vs. 21.77 ± 17.27 days (t = 3.241, p = 0.002). In neonates with VAP, the duration of mechanical ventilation was statistically significantly longer compared with non-VAP patients (16.88 ± 11.99 vs. 5.42 ± 4.48; t = 5.249, p = 0.000). A statistically significant prevalence of Gram-negative bacteria among VAP patients was demonstrated (91%) compared to the Gram-positive (9%), p < 0.05. The leading causative agent of VAP was Klebsiella pneumoniae ESBLs + (27%), followed by Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Escherichia coli (12%). In multivariate logistic regression, mechanical ventilation >7 days was established as an independent risk factor for VAP (OR 3.6; 95% CI: 1.7–6.5, p = 0.003). VAP remains a serious and outstanding issue in pediatric and neonatal intensive care units. The findings of the current study emphasize that the birth weight, gestational age, and duration of hospital stay have a significant association with ventilator-associated pneumonia.

Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study

“…This applies to both the lowest BW classes, that accounted for most infections registered throughout the study period, with the highest HAI incidence rates recorded in the 751–1000 g class probably being the result of a smaller number of patients days spent under surveillance compared to the ≤750 g class. Furthermore, while our results show that prolonged mechanical ventilation, which requires the use of breathing circuits known to be important sources and breeding grounds of pathogenic microorganisms [ 45 ], contributed to the occurrence of HAIs, variables related to the patients’ demographic characteristics and clinical conditions did not influence the outcome. These results partially contrast with those studies in which the male sex and Cesarean section were found to increase HAI occurrence [ 46 , 47 ] but align with findings in which respiratory distress did not show a direct association with HAI onset [ 47 , 48 ].…”

Epidemiology, risk factors, clinical presentation and complications of late-onset neonatal sepsis among preterm neonates in Cyprus: a prospective case-control study

“…Our study showed that longer duration of mechanical ventilation is associated with increased risk of LOS, which is in-line with findings from similar studies and studies on ventilator associated pneumonia (VAP), an infection affecting intubated neonates [ 40 , 41 ]. Characteristically, a recent study demonstrated that in neonates with VAP, the duration of mechanical ventilation was significantly longer compared to neonates without VAP, while the VAP mortality rate was estimated at 9% [ 42 ]. Similarly, newborns with RDS in mechanical ventilation have increased mortality, which may also be associated with LOS [ 43 ].…”

Incidence and outcomes of ventilator associated pneumonia in pediatric patients: an observational study

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