Morrow Brenda M, Argent Andrew C
Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
J Paediatr Child Health. 2009 Mar;45(3):104-11. doi: 10.1111/j.1440-1754.2008.01437.x. Epub 2009 Feb 2.
To obtain preliminary prevalence, aetiological and outcome data on South African paediatric patients with ventilator-associated pneumonia (VAP).
Non-bronchoscopic bronchoalveolar lavage (BAL) specimens taken between January 2004 and September 2005 were prospectively recorded and related clinical data were retrospectively reviewed. VAP was defined as a new isolate on BAL and a modified Clinical Pulmonary Infection Score > or =5.
A total of 230 patients aged 3.9 (2.2-9.1) months (median interquartile range (IQR) ) underwent 309 BALs during 244 paediatric intensive care unit (PICU) admissions. Most patients (84%) were admitted with acute infectious diseases, with a 70% incidence of comorbidity. Thirty-three patients (14.3%) were HIV-exposed but uninfected and 58 (25.2%) were HIV-infected. Of 172 BALs taken > or =48 h after intubation, 63 specimens from 55 patients fulfilled VAP criteria. Acinetobacter baumannii was the most common VAP pathogen, followed by Klebsiella pneumoniae, viruses, yeasts and Staphylococcus aureus. Patients who developed VAP had a higher proportion of comorbid conditions (76% vs. 55%, P= 0.01) and reintubations (39% vs. 12%, P < 0.0001) when compared with non-VAP patients. Median (IQR) length of PICU stay was 12.5 (5-21) days versus 8 (5-14) days (P= 0.03); and the risk adjusted PICU mortality was 1.38 versus 0.79 (P= 0.002) in VAP versus non-VAP patients, respectively.
VAP is associated with significant morbidity and mortality and may relate to the high incidence of comorbid conditions in this population. Primary VAP pathogens differ from developed countries.
获取南非呼吸机相关性肺炎（VAP）儿科患者的初步患病率、病因及预后数据。
前瞻性记录2004年1月至2005年9月间采集的非支气管镜下支气管肺泡灌洗（BAL）标本，并回顾相关临床数据。VAP定义为BAL出现新的分离菌株且改良临床肺部感染评分≥5分。
244例儿科重症监护病房（PICU）住院期间，共230例年龄为3.9（2.2 - 9.1）个月（中位数四分位间距（IQR））的患者接受了309次BAL检查。大多数患者（84%）因急性传染病入院，合并症发生率为70%。33例患者（14.3%）暴露于HIV但未感染，58例（25.2%）为HIV感染。在插管后≥48小时采集的172次BAL检查中，来自55例患者的63份标本符合VAP标准。鲍曼不动杆菌是最常见的VAP病原体，其次是肺炎克雷伯菌、病毒、酵母菌和金黄色葡萄球菌。与非VAP患者相比，发生VAP的患者合并症比例更高（76%对55%，P = 0.01），再次插管率更高（39%对12%，P < 0.0001）。PICU住院时间中位数（IQR）为12.5（5 - 21）天，而非VAP患者为8（5 - 14）天（P = 0.03）；VAP患者与非VAP患者的风险调整后PICU死亡率分别为1.38和0.79（P = 0.002）。
VAP与显著的发病率和死亡率相关，可能与该人群中合并症的高发生率有关。原发性VAP病原体与发达国家不同。
