Log in | Register

Ventilator-associated pneumonia in children after cardiac surgery in The NetherlandsOpen access

P. P. Roeleveld| D. Guijt| E. J. Kuijper| M. G. Hazekamp| R. B. P. de Wilde| E. de Jonge
Pediatric Original
Volume 37, Issue 10 / October , 2011

Pages 1656 - 1663

Abstract

Purpose

We conducted a retrospective cohort study in an academic tertiary care center to characterize ventilator-associated pneumonia (VAP) in pediatric patients after cardiac surgery in The Netherlands.

Methods

All patients following cardiac surgery and mechanically ventilated for ≥24 h were included. The primary outcome was development of VAP. Secondary outcomes were duration of mechanical ventilation and length of ICU stay.

Results

A total of 125 patients were enrolled. Their mean age was 16.5 months. The rate of VAP was 17.1/1,000 mechanical ventilation days. Frequently found organisms were Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Pseudomonas aeruginosa. Patients with VAP had longer duration of ventilation and longer ICU stay. Risk factors associated with the development of VAP were a PRISM III score of ≥10 and transfusion of fresh frozen plasma.

Conclusion

The mean VAP rate in this population is higher than that reported in general pediatric ICU populations. Children with VAP had a prolonged need for mechanical ventilation and a longer ICU stay.

Keywords

References

  1. Elward AM (2003) Pediatric ventilator-associated pneumonia. Pediatr Infect Dis J 22:445–446
    • View reference on PubMed
  2. National Nosocomial Infections Surveillance (NNIS) System (2001) National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992–June 2001, issued August 2001. Am J Infect Control 29:404–421
    • View reference on publisher's website
  3. Tang CW, Liu PY, Huang YF, Pan JY, Lee SS, Hsieh KS, Liu YC, Ger LP (2009) Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan. J Microbiol Immunol Infect 42:413–419
    • View reference on PubMed
  4. Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903
    • View reference on PubMed
  5. Hortal J, Giannella M, Perez MJ, Barrio JM, Desco M, Bouza E, Munoz P (2009) Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med 35:1518–1525
  6. Elward AM, Warren DK, Fraser VJ (2002) Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 109:758–764
    • View reference on PubMed
    • View reference on publisher's website
  7. Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR (2009) A prospective study of ventilator-associated pneumonia in children. Pediatrics 123:1108–1115
    • View reference on PubMed
    • View reference on publisher's website
  8. Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A (2004) Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol 25:753–758
    • View reference on PubMed
    • View reference on publisher's website
  9. Fischer JE, Allen P, Fanconi S (2000) Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia. Intensive Care Med 26:942–949
  10. Tan L, Sun X, Zhu X, Zhang Z, Li J, Shu Q (2004) Epidemiology of nosocomial pneumonia in infants after cardiac surgery. Chest 125:410–417
    • View reference on PubMed
    • View reference on publisher's website
  11. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332
    • View reference on PubMed
    • View reference on publisher's website
  12. Jacobs JP, Jacobs ML, Lacour-Gayet FG, Jenkins KJ, Gauvreau K, Bacha E, Maruszewski B, Clarke DR, Tchervenkov CI, Gaynor JW, Spray TL, Stellin G, O’Bien SM, Elliott MJ, Mavroudis C (2009) Stratification of complexity improves the utility and accuracy of outcomes analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Pediatr Cardiol 30:1117–1130
    • View reference on PubMed
    • View reference on publisher's website
  13. Miller MA, Arndt JL, Konkle MA, Chenoweth CE, Iwashyna TJ, Flaherty KR, Hyzy RC (2011) A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia. J Crit Care 26:280–286
    • View reference on PubMed
    • View reference on publisher's website
  14. Poelaert J, Depuydt P, De Wolf A, Van de Velde S, Herck I, Blot S (2008) Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg 135:771–776
    • View reference on PubMed
    • View reference on publisher's website
  15. National Nosocomial Infections Surveillance (NNIS) System (2004) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485
    • View reference on publisher's website
  16. Raymond J, Aujard Y (2000) Nosocomial infections in pediatric patients: a European, multicenter prospective study. European study group. Infect Control Hosp Epidemiol 21:260–263
    • View reference on PubMed
    • View reference on publisher's website
  17. Craven DE, Chroneou A, Zias N, Hjalmarson KI (2009) Ventilator-associated tracheobronchitis: the impact of targeted antibiotic therapy on patient outcomes. Chest 135:521–528
    • View reference on PubMed
    • View reference on publisher's website
  18. Mentec H, May-Michelangeli L, Rabbat A, Varon E, Le Turdu F, Bleichner G (2004) Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia. A multicentre prospective study. Intensive Care Med 30:1319–1326
  19. Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G (2010) Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of bronchoscopic and non-bronchoscopic methods. Pediatr Crit Care Med 11:258–266
    • View reference on PubMed
    • View reference on publisher's website
  20. Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N (2003) Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth 17:22–28
    • View reference on PubMed
    • View reference on publisher's website
  21. Sarani B, Dunkman WJ, Dean L, Sonnad S, Rohrbach JI, Gracias VH (2008) Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit Care Med 36:1114–1118
    • View reference on PubMed
    • View reference on publisher's website
  22. Hawe CS, Ellis KS, Cairns CJ, Longmate A (2009) Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Med 35:1180–1186
  23. Brilli RJ, Sparling KW, Lake MR, Butcher J, Myers SS, Clark MD, Helpling A, Stutler ME (2008) The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 34:629–638
    • View reference on PubMed
  24. Stokowski LA (2009) Preventing ventilator-associated pneumonia in infants and children. http://www.medscape.org/viewarticle/709081
  25. Bigham MT, Amato R, Bondurrant P, Fridriksson J, Krawczeski CD, Raake J, Ryckman S, Schwartz S, Shaw J, Wells D, Brilli RJ (2009) Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 154:582–587
    • View reference on PubMed
    • View reference on publisher's website
  26. Safdar N, Dezfulian C, Collard HR, Saint S (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement