Prevalence and risk factors associated with the development of ventilator- associated pneumonia in the pediatric intensive care unit of TASH, a retrospective cross-sectional study
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Date
2024-02
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Addis Ababa University
Abstract
Background: Ventilator-associated pneumonia (VAP), is a severe type of hospital-acquired
pneumonia that develops 48 hours after initiation of mechanical ventilation.it is associated with
significant morbidity and mortality. According to the recent literature, the incidence of VAP in
pediatrics is still very variable, with much higher rates in developing countries compared to
developed countries, although there are very few studies from developing countries. The incidence
continues to be high despite an improved understanding of the risk factors of VAP. There is no
consensus on the preventive strategies akin to adults, in the form of a bundle approach in children.
Objectives: This study aimed to determine the prevalence and risk factors associated with the
development of VAP in the PICU of Tikur Anbessa Specialized Hospital (TASH), Addis Ababa,
Ethiopia, 2024
Methodology: A retrospective cross-sectional study was conducted by using a consecutive
sampling method. All pediatric patients who were ventilated for ≥48 hours within the study period
September 2019-september 2023G.C were included. Data was collected from patient charts using
a structured information-extracting tool. Both Bivariate and multivariate logistic regression were
used to study the association between the risk factors and dependent variables. Continuous and
categorical variables were compared using the Chi-square test. Where the P-value of <0.05 was
considered significant.
Result: Among the 161 patient, 93(57.7%) were male and the male to female ratio were 1.4:1.
The mean±SD age was 5.4±4.5 years. The most common admitting diagnosis was
neurologic/neurosurgical condition 44 (27.3%), and cardiovascular diseases 28 (17.4%). The most
common indication for ventilation was coma/ impaired consciousness 76(47.2%) followed by
respiratory failure 73(45.3%).the prevalence of VAP was 33 (20.5%) with a rate per 1000
ventilator days is 27/1000. On multiple logistic regression analysis, the five identified risk factors
were male sex ([AOR]: 34.110, P= 0.043: 95% CI: 1.12-1039.6), Duration of mechanical
ventilation in days ([AOR]: 1.501, P= 0.002: 95% CI: [1.155-1.951]), the presence of
comorbidities (AOR: 31.445, P=0.025), transportation out of PICU while the patient is intubated
([AOR]: 21.456, P= 0.029: 95% CI: [1.369-336.72]) and compliance to VAP bundle ([AOR]:
1031.424, P= 0.026: 95% CI [1.507-655.292]). klebsiella pneumoniae (34%) followed by CONS
(27%) and Acinetobacter Species 6(18%) were the most commonly identified organisms from
tracheal aspirate
Conclusion: The prevalence of ventilator-associated pneumonia in our hospital (TASH) pediatric
intensive care unit is found to be high. The most common causative organisms were Klebsiella
pneumoniae and coagulase-negative staph aureus. Knowing the risk factors will help in planning
and implementing preventive measures
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Keywords
VAP, Ventilator-Associated Pneumonia, PICU, Intensive care, Pediatrics.