Pneumonia nosocomial em crianças sob ventilação mecânica (PAV) internadas na Unidade de Terapia Intensiva Pediátrica (UTI-P) do Hospital de Clínicas da Universidade Federal de Uberlândia

Abstract

A pneumonia case—control study was conducted including 38 mechanically ventilated children interned in Pediatric Intensive Care Unit (PICU) of the Clinical Hospital, Federal University of Uberlandia (HC- UFU), from September 2001 to May 2002, through clinical— radiological criteria, prospective qualitative culture survey from orofaringyx and quantitative culture of endotracheal aspirates (ETA) in regular intervals. About 45% of the children had clinical signs and symtons as well as radiographic pneumonia. Of them microbiological tests were negative in four (23.5%). The microbiologic test showed a sensitivity of 76.5%, specificity 61.9% and positive predictive (61.9%) and negative (76.5%) values. The incidence of ventilator—associated pneumonia (VAP) was 34.2% and mortality 18.4%. The frequency of early—onset VAP (46.1%) and late onset (53.8%) were similar. Klebsiella pneumoniae (44.4%) and Staphylococcus aureus (33.3%) were the most frequent pathogens of two infections, respectively. Two strains of K. pneumoniae belonged to the extended spectrum B-lactamase producer (ESBL) phenotype, in early—onset VAP. Half of S. aureus strains were methicillin resistant (MRSA). The risk factors were not significantly different between two groups although higher values were observed in the children with VAP, including the time of hospitalization (17.4 vs 14.4 days), time of mechanical ventilation (8.5 vs 7.4 days), reinternations (77% vs 48%), antibiotic use (69.2% vs 36%) and 2 3 invasive devices (92.3% vs 88%), as well as death (23.08% vs 16%) and alterations in the upper respiratory tract microflora (84.6% vs 76%) were more associated to VAP. In conclusion, VAP shown to be were very frequent, serious, and usually associated to resistant bacteria, and ETA culture may be an important tool that allows a better approach in these patients.