Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit

Abstract

Background Ventilator associated pneumonia (VAP) caused by more than one microorganisms is not uncommon and may be potentially challenging, but the relevant data is scarce in ventilated neonates. We aimed to investigate the clinical characteristics and outcomes of polymicrobial VAP in the neonatal intensive care unit (NICU). Methods All neonates with definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and September 2020 were prospectively observed and enrolled for analyses. All clinical features, therapeutic interventions and outcomes were compared between the polymicrobial VAP and monomicrobial VAP episodes. Multivariate regression analyses were used to find the independent risk factors for treatment failure. Results Among 236 episodes of neonatal VAP, 60 (25.4%) were caused by more than one microorganisms. Polymicrobial VAP episodes were more likely to be associated with multidrug-resistant pathogens (53.3% versus 34.7%, P = 0.014), more often occurred in later days of life and in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. Otherwise most clinical characteristics of polymicrobial VAP were similar to those of monomicrobial VAP. The therapeutic responses and treatment outcomes were also comparable between these two groups, although modification of therapeutic antibiotics were significantly more common in polymicrobial VAP episodes than monomicrobial VAP episodes (63.3% versus 46.2%; P < 0.001). None of any specific pathogens was significantly associated with worse outcomes. Instead, it is the severity of illness, including presence of concurrent bacteremia, septic shock, and requirement of high-frequency oscillatory ventilator and underlying neurological sequelae that are independently associated with treatment failure. Conclusions Polymicrobial VAP accounted for 25.4% of all neonatal VAP in the NICU, and frequently occurred in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. In our cohort, most clinical features, therapeutic responses and final outcomes of neonates with monomicrobial and polymicrobial VAP did not differ significantly.

Lung Microbiota and Ventilator-Associated Pneumonia in the Neonatal Period

“…A basic aspect of the prevention of healthcare-associated infections is the protection and promotion of the establishment of an appropriate microbiota that competes with pathogens for the colonization of the corresponding ecological niches. In this regard, it is known that early, inappropriate, or excessive use of broad-spectrum antibiotics is significantly associated with the emergence of multidrug-resistant pathogens [ 83 ]. In addition to this, different sets of measures have been developed that, despite the limitation of not having clearly established and universal diagnostic criteria, have shown the effectiveness in reducing VAP in local settings.…”

Accuracy of the spontaneous breathing trial using a combined CPAP + PSV model to predict extubation outcomes in very preterm infants

“…Invasive mechanical ventilation is a common life support technique for very preterm infants (gestational age < 32 weeks) [ 1 ], but prolonged mechanical ventilation can lead to lung injury and an increased risk of complications, such as ventilator-associated pneumonia and bronchopulmonary dysplasia [ 1 – 3 ]. To reduce the occurrence of related complications, clinicians try to have objective criteria to determine the timing of extubation, aiming for earlier extubation and a shorter duration of invasive mechanical ventilation [ 4 ].…”

Fatores Relacionados À Prevalência De Pneumonia Associada À Ventilação Mecânica Em Recém-Nascidos Em Unidades De Terapia Intensiva E Suas Principais Formas De Prevenção

“…Dados da pesquisa (2022) SegundoWang et al (2021), a PAV está associada a maior morbidade nos neonatos, especialmente nos que apresentam bacteremia concomitante, podendo cursar com maior gravidade da enfermidade e com sequelas neurológicas. Ainda vale ressaltar que, além de prejuízos para a saúde do bebê, a prevalência dessa enfermidade causa maiores custos e uso de recursos hospitalares, sobrecarregando ainda mais o sistema de saúde.Ademais, de acordo com Arthur, Kaur e Carey (2022), as definições de PAV mais amplamente aceitas para neonatos não são sensíveis nem específicas em decorrência à subjetividade de achados radiológicos de tórax e achados clínicos propostos pelos Centros de Controle e Prevenção de Doenças (CDC) para a definição de PAV.…”