Ventilator-Associated Pneumonia and Events in Pediatric Intensive Care: A Single Center Study

Pediatr Crit Care Med. 2018 Dec;19(12):1106-1113. doi: 10.1097/PCC.0000000000001720.


Objectives: Ventilator-associated pneumonia is the second most common nosocomial infection in pediatric intensive care. The Centers for Disease Control and Prevention recently issued diagnosis criteria for pediatric ventilator-associated pneumonia and for ventilator-associated events in adults. The objectives of this pediatric study were to determine the prevalence of ventilator-associated pneumonia using these new Centers for Disease Control and Prevention criteria, to describe the risk factors and management of ventilator-associated pneumonia, and to assess a simpler method to detect ventilator-associated pneumonia with ventilator-associated event in critically ill children.

Design: Retrospective, observational, single-center.

Setting: PICU in a tertiary-care university hospital.

Patients: Consecutive critically ill children mechanically ventilated for greater than or equal to 48 hours between November 2013 and November 2015.

Interventions: None.

Measurements and main results: Of 304 patients mechanically ventilated for greater than or equal to 48 hours, 284 were included. Among them, 30 (10.6%) met clinical and radiologic Centers for Disease Control and Prevention criteria for ventilator-associated pneumonia, yielding an prevalence of 7/1,000 mechanical ventilation days. Median time from mechanical ventilation onset to ventilator-associated pneumonia diagnosis was 4 days. Semiquantitative culture of tracheal aspirates was the most common microbiological technique. Gram-negative bacteria were found in 60% of patients, with a predominance of Haemophilus influenzae and Pseudomonas aeruginosa. Antibiotic therapy complied with adult guidelines. Compared with patients without ventilator-associated pneumonia, those with ventilator-associated pneumonia had significantly longer median durations of mechanical ventilation (15 vs 6 d; p < 0.001) and PICU stay (19 vs 9 d; p < 0.001). By univariate analysis, risk factors for ventilator-associated pneumonia were younger age, reintubation, acute respiratory distress syndrome, and continuous enteral feeding. Among the 30 patients with ventilator-associated pneumonia, 17 met adult ventilator-associated event's criteria (sensitivity, 56%).

Conclusions: Ventilator-associated pneumonia is associated with longer times on mechanical ventilation and in the PICU. Using the ventilator-associated event criteria is of interest to rapidly screen for ventilator-associated pneumonia in children. However, sensitivity must be improved by adapting these criteria to children.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Critical Care / methods
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Male
  • Pneumonia, Ventilator-Associated / diagnosis
  • Pneumonia, Ventilator-Associated / drug therapy
  • Pneumonia, Ventilator-Associated / epidemiology*
  • Prevalence
  • Respiration, Artificial / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Time Factors


  • Anti-Bacterial Agents