Condition

Hospital-acquired Pneumonia in Infants and Children

Editors: Zbigniew Fedorowicz PhD, MSc, DPH, BDS, LDSRCS; Stacey Valentine MD, MPH

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Background Information

Description

  • hospital-acquired pneumonia is lung infection that develops ≥ 48 hours after admission and was not present or incubating at time of admission (Crit Care Clin 2013 Jul;29(3):521)
  • ventilator-associated pneumonia (VAP) is lung infection in mechanically ventilated children which develops ≥ 48 hours after start of mechanical ventilation
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Also Called

  • healthcare-associated pneumonia
  • nosocomial pneumonia
  • ventilator-associated pneumonia

Epidemiology

Incidence/Prevalence

  • hospital-acquired pneumonia
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    • reported to develop in 16%-29% of all hospitalized infants and children
    • second most common hospital-acquired infection in critically ill neonates
    • accounts for
      • 10%-15% of all hospital-acquired infections in children
      • 7%-32% of hospital-acquired infections in neonatal intensive care units (NICU)
    • Reference - Paediatr Drugs. 2002;4(2):73-83
  • ventilator-associated pneumonia (VAP)
    • second most common hospital-acquired infection in pediatric and neonatal intensive care units
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    • accounted for 95% of hospital-acquired pneumonia in 1,459 pediatric intensive care unit (ICU) patients (Pediatrics 1999 Apr;103(4):e39)
    • 5% of mechanically ventilated pediatric ICU patients developed VAP in prospective cohort study of 595 children (Pediatrics 2002 May;109(5):758)
    • 28% of mechanically ventilated extremely premature infants developed VAP in prospective cohort of 67 mechanically ventilated infants born at < 28 weeks (Pediatrics 2003 Dec;112(6):1283), editorial can be found in Pediatrics 2003 Dec;112(6):1420
    • rate of VAP 31.8 per 1,000 ventilator-days in pediatric ICU in Egypt, 2008-2010
      • based on prospective observational study of device-associated healthcare-associated infections
      • 143 patients in pediatric ICU for 1,535 days
      • overall 22.8 device-associated healthcare-associated infections per 1,000 ICU days
      • incidence of VAP 31.8 per 1,000 ventilator days
      • Reference - J Infect Public Health 2012 Dec;5(6):394
    • rate of VAP 12.8 per 1,000 days in pediatric ICU and 0.44 per 1,000 days in NICU in Philippines, 2005-2009
      • based on prospective observational study of device-associated healthcare-associated infections
      • 4,952 patients in ICU for 40,733 days
      • overall 4.9 device-associated healthcare-associated infections per 1,000 ICU days
      • incidence of VAP
        • 16.7 per 1,000 ventilator-days in adult ICU
        • 12.8 per 1,000 ventilator-days in pediatric ICU
        • 0.44 per 1,000 ventilator-days in neonatal ICU
      • Reference - Am J Infect Control 2011 Sep;39(7):548
    • STUDY SUMMARY
      decreased incidence of VAP in the United States from 2007 to 2012 among critically ill infants and children
      COHORT STUDY: Pediatrics 2014 Oct;134(4):705

Risk Factors

  • risk factors in neonates include
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    • low birth weight (≤ 1,500 g)
    • low gestational age
    • history of bloodstream infection
    • prolonged mechanical ventilation
    • severe underlying cardiopulmonary disease
    • prolonged IV alimentation
    • prior thoracoabdominal surgery
    • invasive devices (intravascular catheters, endotracheal tubes, orogastric tubes, urinary catheters, drains)
    • prior use of broad-spectrum antibiotics
    • parenteral nutrition
    • medication (steroids, histamine type 2 receptor blockers)
  • risk factors in children include
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    ,
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    • history of bloodstream infection
    • prolonged mechanical ventilation
    • severe underlying cardiopulmonary disease
    • prolonged IV alimentation
    • prior thoracoabdominal surgery
    • prior use of broad-spectrum antibiotics
    • continuous enteral feeding
    • bronchoscopy
    • immunodeficiency/immunosuppressant drugs
    • neuromuscular blockade
    • gastric aspiration
    • chronic obstructive pulmonary disease
    • administration of positive end-expiratory pressure
    • STUDY SUMMARY
      transport for procedures, reintubation, and transfusion associated with increased risk for VAP in patients in pediatric intensive care unit
      COHORT STUDY: Pediatrics 2002 May;109(5):758

    • STUDY SUMMARY
      risk factors present within 72 hours of a positive culture in children with ventilator-associated pneumonia reported to include female gender, postsurgical diagnosis, enteral feeds, and narcotic use
      CASE SERIES: Pediatrics 2009 Apr;123(4):1108

Associated Conditions

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