425 Hospital-Acquired Pneumonia in Critically-Ill Children: Incidence, Risk Factors, Outcome with Insight on Emergency Diagnosis by Multiplex Polymerase Chain Reaction

Abstract

Hospital acquired pneumonia (HAP) is the most frequent hospitalacquired infection in critically ill patients. NNIS system reported that HAP accounts for 31% of all nosocomial infections acquired in medical ICUs. Increasing incidence of infections by antibiotic-resistant pathogens contributes to higher mortality, longer ICU stay and higher costs. So we aimed to identify the incidence of HAP, its risk factors, and its effects on outcome, we evaluated as well the usefulness of multiplex polymerase chain reaction (m-PCR) as a tool for emergency diagnosis of HAP. We examined all consecutive admissions to Pediatric ICU from February 2010 to August 2010. Patients were diagnosed to have HAP when their Clinical Pulmonary Infection Score (CPIS) index was more than 6. Blood and endotracheal aspirate (ETA) were tested for bacterial pathogens by microbiological cultures and multiplex PCR simultaneously. Results Twenty five patients out of 90 admissions (27.7%) developed HAP during the observation period, with incidence rate of 13 per 1000 patient days and overall mortality of 56%. Gastro-esophageal reflux disease (GERD), mechanical ventilation (MV), endotracheal re-intubation and sedation were the main recorded risk factors for HAP. Multiplex-PCR showed better sensitivity and positive predictive value than bacterial culture for etiological diagnosis of HAP. Acinetobacter and Klebsiella pneumoniae were the most common identified pathogens. Conclusion Hospital-acquired pneumonia adversely affects patients outcome in our setting. Moreover, m-PCR permits simultaneous detection of several bacterial pathogens in a single reaction which can optimize the emergency diagnosis of HAP and can improve etiology-directed clinical management of bacterial pneumonia.