scholarly journals Surveillance culture and Gram staining for detecting the causative bacteria of ventilator-associated pneumonia in neonates

2021 ◽  
Author(s):  
Yoshiki Uemura ◽  
Masahiro Enomoto ◽  
Mio Sakuma ◽  
Shin Kikuchi ◽  
Atsuko Takei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Rapid Detection ◽  
Neonatal Intensive Care ◽  
Concordance Rate ◽  
Surveillance Culture ◽  
Ventilator Associated Pneumonia ◽  
Gram Staining ◽  
Concurrent Use ◽  
Tracheal Aspirates

Abstract Background To investigate the efficacy of surveillance culture for the rapid detection of pathogens associated with ventilator-associated pneumonia (VAP) in neonates. Methods A retrospective study was conducted on all patients with VAP in the neonatal intensive care unit. Whether causative bacteria on the culture of tracheal aspirates obtained at the onset of VAP matched with those on Gram staining and weekly surveillance culture was investigated. Result The concordance rate between surveillance culture using samples collected 4–10 days before VAP and causative bacteria was 53%. When Gram staining was performed at the onset of VAP, the concordance rate significantly increased to 86% (p = 0.022). Conclusions The concurrent use of surveillance culture and Gram staining for the detection of causative bacteria may be effective in determining initial treatment among neonates with VAP.

scholarly journals Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 760
Author(s):  
Hsiao-Chin Wang ◽  
Chen-Chu Liao ◽  
Shih-Ming Chu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Failure ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Neurological Sequelae ◽  
Independent Risk Factors

It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.

Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients

2014 ◽  
Vol 20 (10) ◽  
pp. 627-630 ◽  
Author(s):  
Fumiko Kawanishi ◽  
Masami Yoshinaga ◽  
Michiyo Morita ◽  
Yuriko Shibata ◽  
Tomoyuki Yamada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ventilator Associated Pneumonia

One-Week versus 2-Day Ventilator Circuit Change in Neonates with Prolonged Ventilation: Cost-Effectiveness and Impact on Ventilator-Associated Pneumonia

2014 ◽  
Vol 36 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Shih-Ming Chu ◽  
Mei-Chin Yang ◽  
Hsiu-Feng Hsiao ◽  
Jen-Fu Hsu ◽  
Reyin Lien ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Ventilator Circuit ◽  
Mechanical Ventilators ◽  
Prolonged Intubation ◽  
The Impact

ObjectiveTo investigate the impact of 1-week ventilator circuit change on ventilator-associated pneumonia and its cost-effectiveness compared with a 2-day change.DesignAn observational cohort study.SettingA tertiary level neonatal intensive care unit in a university-affiliated teaching hospital in Taiwan.PatientsAll neonates in the neonatal intensive care unit receiving invasive intubation for more than 1 week from July 1, 2011, through December 31, 2013.InterventionWe investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort.Measurements and Main ResultsA total of 361 patients were maintained on mechanical ventilators for 13,981 days. The 2 groups did not differ significantly in any demographic characteristics. The rate of ventilator-associated pneumonia was comparable between the 2-day group and the 7-day group (8.2 vs 9.5 per 1,000 ventilator-days, P=.439). The durations of mechanical ventilation and hospital stay, and rates of bloodstream infection and mortality, were also comparable between the 2 groups. Switching from a 2-day to a 7-day change policy would save our neonatal intensive care unit a yearly sum of US $29,350 and 525 working hours.ConclusionDecreasing the frequency of ventilator circuit changes from every 2 days to once per week is safe and cost-effective in neonates requiring prolonged intubation for more than 1 week.Infect Control Hosp Epidemiol 2014;00(0): 1–7

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