Ventilator Associated Pneumonia Rate Among Extremely Low Gestational age Infants: A Single Center Clinical Audit

Abstract

Background: Ventilator Associated Pneumonia (VAP) in preterm newborns is understudied. A CDC algorithm for VAP exists, however, has never been validated in the preterm population. This is a first attempt to document the rate of VAP and characteristics of preterm infants who are diagnosed with VAP in our NICU. Objective: To determine the incidence of VAP in infants born <28 wks GA in the NICU using the CDC algorithm for clinically defined pneumonia for infants and to describe those patients diagnosed with VAP. Design/Methods: This is a prospective cohort study of infants admitted to one Level 3 NICU in Vancouver, Canada from May 2009 to October 2009. All patients ventilated for >48 h were eligible for screening using the CDC algorithm for VAP. Of particular interest to the study, where patients born <28 wks gestation. Demographic characteristics were collected in addition to clinical variables. The VAP rate was calculated by: number of VAP / number of ventilator days x 1000. Results: 87 patients admitted to our Level 3 NICU were ventilated >48 hours in 6 months in 2009; 35 were <28 wks GA. These patients had a mean GA of 25.5 +/- 1.2 weeks, mean birth weight of 797 +/- 205 g and 60% were male. 4/35 fulfilled CDC criteria for VAP. Two patients had a single organism cultured from an endotracheal aspirate (E. Coli). Details of the cases can be seen in Table 1. The VAP rate was 3.4 cases of VAP/1000 ventilator days. (Table presented) Conclusions: The CDC algorithm has not been validated for the preterm population. Our rate of VAP is relatively higher than published reports [1] . Patients with VAP all had an underlying diagnosis of BPD and were chronically ventilated. Efforts should be made to validate a diagnostic tool specifically for preterm and term newborns.