Risk factors for ventilator-associated pneumonia at the intensive care unit of A childrens hospital between 2012 - 2019 : A case-control study

Introduction: Ventilator-associated pneumonia is the second commonly seen healthcare related infection and one of the most important reasons for mortality in intensive care units. Aim: In this study, we aimed to investigate the risk factors for ventilator-associated pneumonia development in the patients who were hospitalized at a pediatric intensive care unit and under mechanical ventilation. Material-method: This is a case-control study. The case and control groups included 170 patients who were hospitalized at the pediatric intensive care unit of Dr.Behcet Uz Children's Hospital between the period of 1 January 2012 and 1 December 2018. All the patients were under the support of mechanical ventilation for at least 48 hours. The case group included patients with the diagnosis of ventilator-associated pneumonia. The control group were cross-matched patients regarding gender and age and did not develop ventilator-associated pneumonia under mechanical ventilation. The recorded variables included age, gender, primary diagnosis, immigrant status, indication for administration to the pediatric intensive care unit, duration of mechanical ventilation, duration for ventilator-associated pneumonia, PRISM score, presence of immunodeficiency, presence of nasogastric feeding tube, total parenteral nutrition, presence of unplanned intubation, presence of chest tube, history of blood transfusion, presence of central line, presence of enteral feeding, treatment with antibiotics and H2 receptor antagonists, history of cardiopulmonary resuscitation. Results: In this study, the ratio of using H2 receptor antagonistic drugs, presence of hyperglycemia, presence of nasogastric feeding tube was significantly higher in the case group compared to the control group (p<0.001, p=0,005, p=0,026). History of cardiopulmonary resuscitation was significantly higher in the control group compared to the case group (p=0.002). Multiple logistic regression analysis revealed having nasogastric feeding tube and H2 receptor antagonistic drug increases the risk of ventilator-associated pneumonia by 6.5 (CI:1.49-28.84) and 4.17 (CI:2.023-8.626). Presence of hyperglycemia increases the risk of ventilator-associated pneumonia by 2.18 times (CI: 1.073- 4.432). The duration of mechanical ventilation longer than one year and between 3 months to 1 years significantly increase the risk of ventilator-associated pneumonia by 4.29 (CI: 1.081-10.232) and 2.69 (CI: 1.011-7.133) consecutively. An increase of one point in the PRISM score increases the risk of ventilator-associated pneumonia by 8% (CI:1.007-1.163). Conclusion: The development of ventilator-associated pneumonia is a multifactorial process. Notably, using the H2 receptor antagonist drug and the presence of a nasogastric feeding tube are important avoidable factors that increase the risk of ventilator-associated pneumonia. Thus while planning a ventilator-associated pneumonia bundle, the clinicians should take these factors into account. Presence of hyperglycemia can be a predictor of upcoming ventilator-associated pneumonia.