Ventilator-associated pneumonia: incidence and risk factors in the paediatric intensive care unit

Background Ventilator-associated pneumonia (VAP) is one of the endless research topics that is always under focus, as it represents a major problem in the medical and surgical ICUs, especially with the growing problem of continuous settlement of resistant bacterial strains that influence all prevention bundles.Objective The aim of this study was to update the incidence, risk factors, and outcome of VAP in PICU.Patients and methods This prospective observational study was conducted on 300 cases admitted to the PICU in Zagazig University Hospitals, Egypt. All children were radiologically free means have no abnormal lung aeration findings. And connected to mechanical ventilation due to non-pulmonary cause. Follow-up of the cases was scheduled, and radiological, clinical and laboratory data were obtained throughout their ICU stay and according to their days of MV.Results The incidence of VAP was 37.56 per 1000 ventilation days of PICU patients. The commonest significant risk factors for VAP among the studied group were reintubation [relative risk (RR)=1.53; 95% confidence interval (CI): 1.01–32.24], exposure to sedation (RR=8.13; 95% CI: 2.05–32.24), rate of suction greater than or equal to 3 h interval (RR=2.72; 95% CI: 1.62–4.54), recumbent position (RR=2.69; 95% CI: 1.54–4.71), interval of oral hygiene (RR=1.84; 95% CI: 1.21–2.8), and ineffective hand hygiene (RR=1.51; 95% CI: 1.01–2.5). Multivariate regression analysis revealed that reintubation, rate of oral hygiene greater than 3 h, and duration of MV greater than 7 days are independent risk factors for VAP. Moreover, there was a nonsignificant relation between presence of VAP and mortality among studied patients.Conclusions The main risk factors for VAP are reintubation, longevity of MV, and the rate of oral hygiene. Close monitoring and training of all ICU staff is recommended.