Ventilator-associated pneumonia in neonates, infants and children

Abstract

Ventilator-associated pneumonia (VAP) is relatively common in mechanically-ventilated children, but there is a wide variation in reported VAP rates, depending on settings and geographical regions. Surveillance definitions in children are challenging. Although these are provided by the German nosocomial infection surveillance system and an independent Dutch group, the combination of clinical and radiologic signs leaves room for interpretation. Of note, the United States Centers for Disease Prevention and Control guidelines do not offer algorithms for neonates. Despite the fact that most experts agree on the low sensitivity and specificity of existing definitions, little has changed over the past years. However, the number of studies reporting on VAP prevention programs has increased in recent years. Single interventions, such as chlorhexidine mouth wash or stress ulcer prophylaxis, were not effective. Successful prevention programs combined multiple interventions, such as hand hygiene, glove and gown use for endotracheal tube manipulation, backrest elevation, oral care with chlorhexidine, stress ulcer prophylaxis, cuff pressure maintenance where appropriate, use of orogastric tubes, avoidance of gastric overdistension, and elimination of non-essential tracheal suction. These multimodal strategies have proved to be successful among neonates, infants, and children. Importantly, they are applicable in high-as well as in low-and middle-income countries. This review provides an update of VAP incidence rates and summarizes current knowledge on its epidemiology, risk factors, surveillance definitions, and prevention programs in the pediatric setting.

Persistent Isolation of Multidrug Resistant Gram-Negative Bacteria From Mechanically Ventilated Newborns in a Newly Established Neonatal Intensive Care Unit

“…Consistent with many other studies (6,8,9), this report also highlights the presence of gram negative bacteria especially, gram negative nil fermenters like Acinetobacter and Pseudomonas as more usual causes of VAP as compared to gram positive organisms, which used to be the major culprits in previous decades. Moreover, all the gramnegative organisms that were isolated in the present study were resistant to multiple drugs sparing only the reserved antibiotics like carbapenems and polymyxins.…”

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

“…VAP is the second most common healthcare‐associated infection which accounts for 22.7% of these infections in paediatric intensive care units (PICUs) (Aelami, Lotfi, & Zingg, ; Bigham et al, ). According to the National Healthcare Safety Network report, VAP rates varied between 0.2/1,000 ventilator days to 0.8/1,000 ventilator days in the US PICUs in 2012 (Dudeck et al, ).…”

“…VAP is the second most common healthcare-associated infection which accounts for 22.7% of these infections in paediatric intensive care units (PICUs) (Aelami, Lotfi, & Zingg, 2014;Bigham et al, 2009).…”

Neonatal sepsis: Highlighting the principles of diagnosis and management

“…[21] An organism may be considered significant if ≥10 6 CFU/mL are present. [23] A negative tracheal aspirate culture has a high negative predictive value for excluding a VAP. [21] The radiographic picture, clinical, and laboratory criteria may be used to make the diagnosis of VAP without a culture result.…”