Am. J. Respir. Crit. Care Med., Vol 155, No. 1, Jan 1997, 162-169.
Nosocomial pneumonia and tracheitis in a pediatric intensive care unit: a prospective study
MJ Fayon, M Tucci, J Lacroix, CA Farrell, M Gauthier, L Lafleur and D Nadeau
Department of Pediatrics, Sainte-Justine Hospital, Universite de Montreal, Quebec, Canada.
We conducted a prospective study in the multidisciplinary pediatric
intensive care unit (pediatric ICU) of a tertiary-care university hospital
in order to determine the incidence, risk markers, risk factors, and
complications related to bacterial nosocomial pneumonia (BNP) and
tracheitis (BNT) in children. A cohort of 1,114 consecutive admissions to
the pediatric ICU was enrolled over a 56-wk period; 154 cases were excluded
mostly (75%) because they already had a respiratory infection at entry. The
final sample included 960 admissions (831 patients). Diagnosis of BNP or
BNT was based on Centers for Disease Control of Atlanta criteria using a
consensus method involving three experts, who also attributed complications
to BNP and BNT. A total of 29 BNP and BNT (3.0%; 95% CI: 1.1 to 4.1%) were
diagnosed (BNP: 1.2%, 95% CI: 0.7 to 1.9%; BNT: 1.8%, 95% CI: 0.8 to 2.6%).
Three factors were retained by multivariate analysis as independent risk
factors or markers for BNP (immunodeficiency, immunosuppression, and
neuromuscular blockade), and two for BNT (head trauma and respiratory
failure). Gram- negative bacteria and Staphylococcus aureus were the
microorganisms most frequently found in the tracheal aspirates.
Prescription of antibiotics was commonly attributable to BNP (75%) and BNT
(59%). Death, as well as multiple organ system failure, resulted from BNP
in 8% of cases, but never from BNT. In BNT, the reintubation rate was 24%.
Nosocomial bacterial respiratory infections are rare in critically ill
children. However, BNP causes significant complications, and more attention
should be focused on BNT in the critically ill child.
