Comparison of Patient Profiles of Ventilator-Associated Pneumonia versus Non-Ventilator Associated Pneumonia in Children from Rawalpindi

Danial Mehmood; Shamama  Hassan; Samina  Tabussam; Bilal  Akhlaq; Haider  Ali; Sumbal  Malik

doi:10.51253/pafmj.v76iSUPPL-1.11866

Authors

Danial Mehmood Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Shamama Hassan Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Samina Tabussam Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Bilal Akhlaq Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Haider Ali Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Sumbal Malik Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.11866

Keywords:

Anti-Bacterial Agents, Intensive Care Units, Pneumonia-Ventilator-Associated, Respiratory Tract Infections, Sepsis

Abstract

Objective: To study paediatric patient profiles for comparing demographic and clinical variables between ventilator-associated pneumonia patients and non-ventilator-associated pneumonia patients.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Paediatrics, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Jul 2024.

Methodology: This study included 200 patients aged between 1 month and 15 years who were divided into two groups: Group-A, containing patients diagnosed with ventilator-associated pneumonia (VAP), based on clinical, radiological, and microbiological findings after experiencing more than 48 hours of mechanical ventilation, and Group-B, which included patients not having ventilator-associated pneumonia (non-VAP) after being ventilated for more than 48 hours. Demographic and clinical variables involved duration of paediatric intensive care unit (PICU) stay, body temperature, total leukocyte count (TLC), duration of antibiotic use, frequency of sepsis, shock, altered sensorium, and mortality.

Results: The mean duration of PICU stay (11.12±2.60 days), mean core body temperature (99.35±1.40°C), mean TLC (19.45±2.79 × 10⁹/L), mean duration of antibiotic use (8.14±0.91 days), frequency of sepsis and shock (37% & 13%), altered sensorium (8%), steroid use (35%), and mortality (20%) were significantly higher (p<0.05) in Group-A than in Group-B patients.

Conclusion: Ventilator-associated pneumonia patients exhibited significantly higher illness severity and mortality, which highlighted the need for vigilant monitoring and early intervention.

Downloads

Download data is not yet available.

References

1. Hernandez-Garcia M, Girona-Alarcon M, Bobillo-Perez S, Urrea-Ayala M, Sole-Ribalta A, Balaguer M, et al. Ventilator-associated pneumonia is linked to a worse prognosis than community-acquired pneumonia in children. PLoS One 2022; 17(7): e0271450. https://doi.org/10.1371/journal.pone.0271450

2. Wyk LV, Applegate JT, Salie S. Ventilator-associated pneumonia in PICU - how are we doing? S Afr J Crit Care 2022; 38(2): 7196.

https://doi.org/10.7196/SAJCC.2022.v38i2.536

3. Iosifidis E, Pitsava G, Roilides E. Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention. Future Microbiol 2018; 13(12): 1431–1446. https://doi.org/10.2217/fmb-2018-0108

4. Kenaa B, O’Hara LM, Richert ME, Brown JP, Shanholtz C, Armahizer MJ, et al. A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians: exploring opportunities for diagnostic stewardship. Infect Control Hosp Epidemiol 2022; 43(3): 284–290. https://doi.org/10.1017/ice.2021.130

5. Antalová N, Klučka J, Říhová M, Poláčková S, Pokorná A, Štourač P. Ventilator-associated pneumonia prevention in pediatric patients: narrative review. Children 2022; 9(10): 1540.

https://doi.org/10.3390/children9101540

6. Khan F, Khan MA, Alam S, Nisa ZU, Kafeel B, Shumail, et al. Isolated pattern of microorganism among pediatric patients with ventilator-associated pneumonia (VAP) in a tertiary care hospital Karachi. J Pharm Res Int 2022; 34(19B): 1–8.

https://doi.org/10.9734/JPRI/2022/v34i19B35805

7. Sultan MA, Masood M, Shabbir SG, Sheikh S, Naqvi SUB, Butt MA. Frequency of ventilator-associated pneumonia in pediatric ICU of Allied Hospital, Faisalabad. Ann Punj Med Coll 2017; 11(3): 261–264. https://doi.org/10.29054/apmc/2017.208

8. Galal YS, Youssef MR, Ibrahiem SK. Ventilator-associated pneumonia: Incidence, risk factors and outcome in paediatric intensive care units at Cairo University Hospital. J Clin Diagn Res 2016; 10(6): SC06–SC11.

https://doi.org/10.7860/JCDR/2016/18570.7920

9. Miura S, Fukushima M, Kurosawa H, Kimura S. Epidemiology of long-stay patients in the pediatric intensive care unit: prevalence, characteristics, resource consumption and complications. J Public Health 2022; 30(1): 111–119.

https://doi.org/10.1007/s10389-020-01282-3

10. Peña-López Y, Campins-Martí M, Slöcker-Barrio M, Bustinza A, Alejandre C, Jordán-García I, et al. Ventilator-associated events in children: a multicentre prospective cohort study. Anaesth Crit Care Pain Med 2022; 41(3): 101072.

https://doi.org/10.1016/j.accpm.2022.101072

11. Chen R, Liu Y, Zhang X, Yang Q, Wang X. Risk factors and nursing countermeasures of ventilator-associated pneumonia in children in the intensive care unit. J Healthc Eng 2022; 2022(1): 905558. https://doi.org/10.1155/2022/9055587

12. Atul K, Neelam G, Aditi G, Garg H. A study of ventilator-associated pneumonia in preterm neonates in neonatal intensive care unit. Eur J Cardiovasc Med 2023; 13(2): 231–237.

https://doi.org/10.1542/peds.112.6.1283

13. Wang S, Yin F, Zhang Y, An K, Xi Y, Lu X, et al. Epidemiology and clinical characteristics of pediatric sepsis in PICUs of China: a national cross‐sectional study. Med Comm 2023; 4(1): e211. https://doi.org/10.1002/mco2.211

14. Bhattacharya P, Kumar A, Ghosh SK, Kumar S, Ghosh S. Ventilator-associated pneumonia in paediatric intensive care unit patients: microbiological profile, risk factors, and outcome. Cureus 2023; 15(4): e37178.

https://doi.org/10.7759/cureus.37178

15. Amanati A, Karimi A, Fahimzad A, Shamshiri AR, Fallah F, Mahdavi A, et al. Incidence of ventilator-associated pneumonia in critically ill children undergoing mechanical ventilation in pediatric intensive care unit. Children 2017; 4(7): 57.

https://doi.org/10.3390/children4070056

16. Mustafa ZU, Khan AH, Salman M, Sulaiman SAS, Godman B. Antimicrobial utilization among neonates and children: a multicenter point prevalence study from leading children’s hospitals in Punjab, Pakistan. Antibiotics 2022; 11(8): 1056.

https://doi.org/10.3390/antibiotics11081056

17. Kalamitsou S, Violaki A, Iosifidis E, Avramidou V, Mantzafleri P-E, Karaiskou E, et al. Ventilator-associated pneumonia (VAP) in children: a diagnostic challenge. Signa Vitae 2023; 19(4): 6–19.

https://doi.org/10.22514/sv.2023.050

18. Mokhtar WA, Sherief LM, Kamal NM, Kamel SEA. Mortality rate in mechanically ventilated neonates: a developing country experience. Iran J Neonatol 2021; 12(2): 1–7.

https://doi.org/10.22038/ijn.2021.33734.1488

19. Osman S, Al Talhi YM, AlDabbagh M, Baksh M, Osman M, Azzam M. The incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: comparison between pre- and post-VAP prevention bundle. J Infect Public Health 2020; 13(4): 552–557. https://doi.org/10.1016/j.jiph.2019.09.015

20. Deraz TE, Hassanein AI, Mansour MGE, El Wakeel MA, Farid NM. Oropharyngeal colonization: a risk factor of ventilator-associated pneumonia in critically ill children. Res J Pharm Biol Chem Sci 2016; 7(6): 900–908.

21. Ayaz I, Hameed H, Amber W, Zafar T. Nosocomial bloodstream infections in pediatric intensive care unit of Fauji Foundation Hospital, Rawalpindi, Pakistan. J Islamabad Med Dent Coll 2020; 9(4): 269–274.

https://doi.org/10.35787/jimdc.v9i4.533

22. Mourani PM, Sontag MK, Williamson KM, Harris JK, Reeder R, Locandro C, et al. Temporal airway microbiome changes related to ventilator-associated pneumonia in children. Eur Respir J 2021; 57(3): 20018209.

https://doi.org/10.1183/13993003.01829-2020