Incidence of Ventilator-Associated Pneumonia in Preterm Very Low Birth Weight Neonates with Positive Tracheal Aspirate Cultures

Abstract

Background: Ventilator-associated pneumonia (VAP) is the second most common cause of healthcare-associated infection in critically-ill children and neonates. There is currently no international gold standard regarding diagnostic criteria and management. Positive tracheal aspirate cultures are a frequent reason for empiric antibiotic therapy in neonates with suspected VAP.
Objectives: To evaluate the incidence of VAP, the sensibility of VAP diagnosis, and the most common microorganisms isolated from the tracheal aspirate cultures of preterm very low birth weight neonates with positive tracheal aspirate cultures.
Methods:This cross-sectional descriptive study included preterm neonates with birth weight < 1,500 grams, hospitalized in the NICU of Chiangrai Prachanukroh Hospital, with positive tracheal aspirate cultures between 1 October 2017 to 30 September 2021. VAP diagnosis was reviewed according to the Clinically defined pneumonia criteria by the Department of DiseaseControl, with reference to the USCDC:Criteria for defining nosocomial pneumonia for infants ≤ 1 year old.
Results: Among the 65 episodes of positive tracheal aspirates identified, approximately half were male (44.6%), the mean gestational age was 28 weeks (SD ± 1.8), and the mean birth weight was 962.8 grams (SD ± 207.4). The incidence of VAP in accordance with the criteria was 56.9% (37 episodes), with a mean duration of 13.1 days(SD ± 6.8) of intubation
before onset. The incidence of non-VAP was 43.1% (28 episodes). The incidence of VAP diagnosis that was discordant with the criteria was 13.8% (9 episodes), with a positive predictive value of 80.4%. The most common microorganisms isolated from the tracheal aspirate cultures wereAcinetobacter baumannii (MDR)(46%), andPseudomonas aeruginosa (32.4%), respectively.
Conclusion: The incidence of VAP in accordance with the criteria in preterm very low birth weight neonates with positive tracheal aspirate cultures was 56.9% (37 out of 65 episodes). The incidence of non-VAP was 43.1% (28 out of 65 episodes). The incidence of VAP diagnosis that was discordant with the criteria was 13.8% (9 out of 65 episodes). The most common microorganism from the tracheal aspirate cultures was Acinetobacter baumannii (MDR).