Torres NP, Flores MB, Hernández DL, Vázquez ZG, Flores NG

Language: Spanish
References: 14
Page: 46-49
PDF size: 143.63 Kb.

ABSTRACT

Background: ventilator associated pneumonia in children and adults is the most common nosocomial infection in intensive care units and contributes to mortality.
Objective: To determine the frequency of ventilator associated pneumonia in neonatal and pediatric intensive care units at a general hospital.
Material and methods: Retrospective, transversal and descriptive study. We reviewed the medical records of patients with mechanical ventilation to determine the frequency of ventilator-associated pneumonia. We analyzed demographic data, radiological description, hematic cytology result, characteristics of secretions, duration of mechanical ventilation and microorganisms reported in cultures of bronchial secretions.
Results: We reviewed 300 medical records of a period of two years. We found 80 cases with diagnostic criteria for ventilatorassociated pneumonia and found a prevalence of 26%. Of the reported cases, 61 (76%) were neonates and 19 (24%) infants, schoolchildren and adolescents. Of the newborns, 48 (79%) were preterm. Imaging studies showed bilateral interstitial infiltrate in 100% of cases. The average days on mechanical ventilation was 11. The secretions were thick in 45% of patients. We used the closed technique of suctioning in 80% of patients. In laboratory tests were reported leukocytosis in 46%, bandemia in 31% and leukopenia in 23%. The causative agents isolated from cultures of bronchial secretions were Klebsiella pneumoniae in 43% of patients, Enterobacter cloacae in 18%, 13% Escherichia coli, Acinetobacter baumannii calcoaceticcus 12%, Streptococcus viridans in 8%, Pseudomonas aeruginosa in 3% and Candida sp in 3%.
Conclusions: We found a prevalence of 26% of ventilator-associated pneumonia in the population studied. Klebsiella pneumoniae was the most common causative agent.

REFERENCES

1. Abramezyc ML, Werther BC, Carvallo ES, Madeiros E. Nosocomial infection in a pediatric intensive care unit in developing country. Braz Infectious Dis. 2003;7:3765-3768.

2. Hernández E, Rivera F, García MF, Castañeda LR, Estrada HA. Neumonía nosocomial asociada a ventilación mecánica en niños atendidos en una unidad de cuidados intensivos. Rev Mex Pediatr 2001;68(3):86-91.

3. Martínez-Aguilar G, Anaya-Arriaga MC, Avila-Figueroa C. Incidencia de bacteriemia y neumonía nosocomial en una unidad de pediatría. Salud Pública Mex 2001;43:515-523.

4. Ostos OL, Cifuentes Y, Hernández BR, Muñoz ML y col. Neumonía nosocomial. Nova publicación científica 2006;4:94-99.

5. Torres-Amaya MA, Castorena-Villa I, Olvera-López G, Cubría- Juárez MP. Incidencia de neumonía asociada a ventilación mecánica en la unidad de terapia intensiva pediátrica. Rev Hosp Juárez Mex 2008;75:247-56.

6. Valencia RJM, Peralta CP. Incidencia de neumonía nosocomial en el Hospital Infantil del Estado de Sonora. Bol Med Hosp Infant Son 1999;16:84-88.

7. Gauvin F, Dassa C, Mahamdou PF, et al. Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods. Crit Care Med 2003;4:437- 443.

8. Apisarnthanarak A, Holxmsnn-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-Associated Pneumonia in extremely preterm neonates in neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003;112:1283-1289.

9. Elward AE, Warren DK, Fraser VJ. Ventilator-associated pneumonia in pediatric intensive care unit patients: Risk factors and outcomes. Pediatrics 2003;109:758-764.

10. Roig AT, Santurio GAM, Ortiz RC. Algunos factores relacionados con la neumonía adquirida en la ventilación. Rev Cubana Pediatr 2005;77(1):24-27.

11. Dodek P, Keenan S, Cook D, Heyland D, Jacka M, et. al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004;141:305-313.

12. Babcock H, Zack J, Garrison T, Trivillion E, Jones M, et al. Educational Intervention to reduce ventilator-associated pneumonia in an integrated health system. Chest 2004;125:224-223.

13. Zaidi M, Martín G, Rosado R. Epidemia de neumonía asociada a ventilación mecánica en Mérida, Yucatán. Salud Pública Mex 1999;41(supl 1):s38-s43.

14. Norma Oficial Mexicana de emergencia para la vigilancia epidemiológica, prevención y control de las infecciones nosocomiales, NOM-EM-002-SSA2-2003.