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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 1  |  Page : 73-77

Ventilator-associated pneumonia in the neonatal intensive care unit


Department of Pediatrics, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt

Correspondence Address:
Wessam F. Soliman
MBBCh, Neonatal Intensive Care Unit, Benha Children's Hospital, Banha, 13511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.132753

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Objective Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients. It is considered to be most important cause of infection-related death in the ICU. We studied the characteristics and risk factors of VAP in critically ill neonates. Background VAP, which was not present at the time of intubation, accounted for up to 30% of nosocomial infections in neonatal intensive care unit (NICU) patients. Patients and methods This study was carried out in the NICU in Benha Children's Hospital on 85 neonates with different diagnoses admitted from April to October 2012 who needed mechanical ventilation. All studied neonates were subjected to history taking, clinical examination, routine investigations (assessment of complete blood count, C-reactive protein levels, and arterial blood gas volumes, blood culture, and liver, serum albumin, and kidney function tests), and chest radiography daily, as well as to nonbronchoscopic alveolar lavage culture. Results Of 85 neonates who needed mechanical ventilation, 55.2% developed VAP. Prematurity, low birth weight, and prolonged duration of mechanical ventilation were risk factors for developing VAP. Increased total leukocyte count, C-reactive protein, and hypoalbuminemia were significantly present in the VAP group. There were significant differences between VAP and non-VAP groups regarding hypothermia, mucopurulent endotracheal tube secretion, PaCO 2 , and PaO 2 . The microorganisms associated with bloodstream infection in the VAP-diagnosed group were Staphylococcus aureus (15%), Klebsiella spp.(8.5%), Candida spp.(6.5%), Pseudomonas spp. (4.2%), and Escherichia coli (4.2%); 61.7% of obtained blood cultures in VAP patients were sterile. The results of nonbronchoscopic bronchoalveolar lavage cultures revealed the presence of Klebsiella spp. (34%), Pseudomonas spp. (25.5%), S. aureus (17%), E. coli (17%), and Candida spp. (6.4%). K. pneumoniae was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. Conclusion The most important risk factors of VAP are prematurity, low birth weight, prolonged duration of mechanical ventilation, enteral nutrition, and umbilical catheterization.


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