Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia

Abstract

Background: Prevention of ventilator-associated pneumonia (VAP) is a major patient safety goal, but accurate identification of VAP in pediatric patients remains challenging.

Methods: We performed a retrospective cohort study to demonstrate feasibility of endotracheal culture and Gram's stain to support VAP diagnosis. Pediatric intensive care unit and cardiac intensive care unit patients with ≥ 1 endotracheal specimen having growth of ≥ 1 organism in conjunction with moderate/many polymorphonuclear leukocytes (ie, the modified microbiologic criterion) were included. Medical records were reviewed for presence/absence of clinical and radiographic Centers for Disease Control and Prevention (CDC) criteria for VAP. Antimicrobial use data were collected before and after culture results were known.

Results: Of 102 patients meeting inclusion criteria, 28% (n = 28) also met both clinical and radiographic CDC criteria for VAP (ie, diagnosis of PNU2). An additional 63% (n = 64) met clinical (36%; n = 37) or radiographic (27%; n = 27) criteria, but not both. Ten patients (9%) had neither clinical nor radiographic criteria for VAP. The majority (63%; n = 64) were receiving antibiotics at time of endotracheal specimen collection. Culture identification resulted in altered antimicrobial therapy in 66% of patients (n = 67).

Conclusions: Our study demonstrates the feasibility of endotracheal Gram's stain and culture for diagnosis of pediatric VAP that could potentially standardize accurate surveillance and management of pediatric VAP.

Keywords: Endotracheal cultures; Hospital-acquired infection; VAP.