Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia

• Accurate identification of VAP in pediatric patients remains challenging.
• A Modified Microbiologic Criterion incorporating ET specimens for diagnosis of pediatric VAP is proposed.
• This retrospective study of 102 pediatric subjects demonstrates feasibility of this criterion.
• The Modified Criterion could standardize accurate surveillance and management of VAP.
• The Modified Criterion could enhance antimicrobial stewardship efforts.

BackgroundPrevention of ventilator-associated pneumonia (VAP) is a major patient safety goal, but accurate identification of VAP in pediatric patients remains challenging.MethodsWe performed a retrospective cohort study to demonstrate feasibility of endotracheal culture and Gram's stain to support VAP diagnosis. Pediatric intensive care unit and cardiac intensive care unit patients with ≥1 endotracheal specimen having growth of ≥1 organism in conjunction with moderate/many polymorphonuclear leukocytes (ie, the modified microbiologic criterion) were included. Medical records were reviewed for presence/absence of clinical and radiographic Centers for Disease Control and Prevention (CDC) criteria for VAP. Antimicrobial use data were collected before and after culture results were known.ResultsOf 102 patients meeting inclusion criteria, 28% (n = 28) also met both clinical and radiographic CDC criteria for VAP (ie, diagnosis of PNU2). An additional 63% (n = 64) met clinical (36%; n = 37) or radiographic (27%; n = 27) criteria, but not both. Ten patients (9%) had neither clinical nor radiographic criteria for VAP. The majority (63%; n = 64) were receiving antibiotics at time of endotracheal specimen collection. Culture identification resulted in altered antimicrobial therapy in 66% of patients (n = 67).ConclusionsOur study demonstrates the feasibility of endotracheal Gram's stain and culture for diagnosis of pediatric VAP that could potentially standardize accurate surveillance and management of pediatric VAP.