Ventilator-Associated Pneumonia is Linked to a Worse Prognosis Than Community-Acquired Pneumonia in Children

Abstract

BackgroundAround 12-20% of patients with community-acquired pneumonia (CAP) require critical care. Ventilator-associated pneumonia (VAP) is the second cause of nosocomial infection in Paediatric Intensive Care Units (PICU). As far as we know, there are no studies comparing both types of pneumonia in children, thus it remains unclear if there are differences between them in terms of severity and outcomes. ObjectiveThe aim was to compare clinical and microbiological characteristics and outcomes of patients with severe CAP and VAP.MethodsA retrospective descriptive study, including patients diagnosed of VAP and CAP, with a positive respiratory culture and under mechanical ventilation, admitted to the PICU from 2015 to 2019.Results238 patients were included; 163 (68.4%) with CAP, and 75 (31.5%) with VAP. Patients with VAP needed longer mechanical ventilation (14 vs. 7 days, p<0.001) and more inotropic support (49.3 vs. 30.7%, p=0.006). Patients with VAP had higher mortality (12 vs. 2.5%, p=0.005).Enterobacteriaceae were more involved with VAP than with CAP (48 vs. 9%, p<0.001). Taking into account only de non-drug sensitive microorganisms, patients with VAP tended to have more multidrug-resistant bacteria (30 vs. 10.8%, p=0.141) than patients with CAP. ConclusionPatients with VAP had worse prognosis than patients with CAP, needing longer mechanical ventilation, more inotropic support and had higher mortality. Patients with VAP were mainly infected by Enterobacteriaceae and had more multidrug resistant microorganisms than patients with CAP.

Mortality Rate and Causing Factors in Ventilator Associated Pneumonia in Children

“…It is important to determine the exposure to VAP at each facility in order to implement and strengthen prevention strategies. VAP is associated not only with an increase in deaths, but additionallyenhance the stay time in the intensive care unit, cost of treatment and increase the chances of ventilation dependence 7 . Several causing factors have been recognized that may stimulus the VAP development.…”