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Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.
MedLine Citation:
PMID:  21499084     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: To determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit. DESIGN:: Prospective cohort study. SETTING:: Pediatric intensive care unit with 16 medical and surgical beds in a tertiary teaching hospital in Recife, northeast Brazil. PATIENTS:: Patients aged <18 yrs were consecutively enrolled between January 2005 and June 2006 into a cohort set to investigate health care-associated infections. Newborns and patients admitted for surveillance and those staying for <24 hrs were excluded. Patients were followed up daily throughout the stay and until 48 hrs after discharge from the unit. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: This report focuses on health care-associated pneumonia, defined as pneumonia that occurs >48 hrs after admission but that was not incubating at the time of admission, as the primary outcome. Intrinsic and extrinsic variables were prospectively recorded into a standardized form. Statistical analyses, including multivariable logistic regression, were performed in Stata version 9.1. There were 765 eligible admissions. Health care-associated pneumonia occurred in 51 (6.7%) patients with an incidence density of 13.1 episodes/1000 patient-days. There were 366 (47.8%) patients on mechanical ventilation, of whom 39 (10.7%) presented with ventilator-associated pneumonia with an incidence density of 27.1/1000 days on ventilation. Longer stay on ventilation (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08), use of gastric tube (OR, 2.88; 95% CI, 1.41-5.87), and of sedatives/analgesics (OR, 2.45; 95% CI, 1.27-4.72) were identified as independent risk factors for healthcare-associated pneumonia. CONCLUSION:: Identification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.
Authors:
Roberto J A Casado; Maria Júlia G de Mello; Rosana C F de Aragão; Maria de Fátima P M de Albuquerque; Jailson B Correia
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Instituto de Medicina Integral Prof. Fernando Figueira-IMIP (RJAC, MJGdM, RCFA, JBC), Pernambuco, Brazil; Faculdade Pernambucana de Saúde (MJGdM); Faculdade de, Ciências Médicas, Universidade de Pernambuco (RCdFA, JBC); Centro de Pesquisas, Aggeu Magalhães, Fundação Osvaldo Cruz (MdFPMA); Universidade Federal de, Pernambuco (MdFPMA).
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