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Diagnosing ventilator-associated pneumonia in pediatric patients with limited facilities: a retrospective cohort study

Irene Yuniar, Immanuela Hartono, Sita Febriani

Background: Ventilator Associated Pneumonia (VAP) is the second leading cause of Healthcare Associated Infection in the PICU. However, there are no specific criteria for diagnosing VAP in pediatric patients. This study evaluates the sensitivity and specificity of CDC pediatric VAP definition to adult Ventilator Associated Event (VAE) criteria in diagnosing VAP in pediatric patients, the risk factors and common organisms causing VAP. Methods: A retrospective study evaluated patients aged 1 month to 12 years admitted to the PICU tertiary hospital Cipto Mangunkusumo from January 2019 to June 2019, who received mechanical ventilation for ≥ 2 days. Results: From 103 patients, 18 (13.85%) and 9 (8.74%) patients developed VAP according to VAE and CDC respectively. The specificity of VAE and CDC criteria reached 100% and 96.9% respectively with 45% and 22.5% in sensitivity. Logistic regression analysis found that duration of mechanical ventilator >5 days (OR 7.519; 95% CI:2.26,25; P=0.001), re-intubation within 72 hours after extubation (OR 4.057; 95% CI:1.36,12.09; P=0.009), usage of vasoactive drugs (OR 4.364; 95% CI:0.94,20.27; P=0.044) and proton pump inhibitor (OR 5.00; 95% CI:1.52,16.47; P=0.005) as the risk factors for VAP. Pseudomonas aeruginosa, klebsiella pneumonia and acinetobacter are the most common organisms found in the VAP group. Conclusion: VAE has higher sensitivity and specificity compared to CDC’s new criteria to diagnose VAP in pediatric patients. However, the new CDC criteria have high specificity and will help physicians in limited facilities diagnose VAP in immunocompetent pediatric patients without the need to conduct invasive examinations like BAL examinations.