Ventilator Associated Pneumonia In Neonatal Intensive Care Units

Yıl 2016, Cilt: 13 Sayı: 3, 130 - 134, 01.07.2016

İsmail Kürşad Gökce

Öz

Ventilator-associated pneumonia VAP is the second most common nosocomial infection in the neonatal intensive care units NİCU which, is a serious complications of mechanical ventilation. The duration of hospitalization and mortality rate may increase due to VAP in the NİCU. The diagnosis is confirmed by the evaluation of clinical and radiological findings. It’s difficult to obtain non-contaminated samples of the lower respiratory airway and microbiological examination during the neonatal period. Therefore, antibiotic therapy is often given empirically. Recently, the culture and microscopic examination of the sample obtained by blind or non-bronchoscopic bronchoalveolar lavage for the diagnosis of VAP shown to have high sensitivity and specificity. These techniques are applicable in the neonatal period. Ventilator-associated pneumonia is a preventable hospital-acquired infections. The collection of applications in a package to reduce the rate of ventilator-associated pneumonia and full implementation of these applications are called as bundle approach. Bundle approach achieved a significant reduction in the VAP rate. This review aimed to provide current information about the prevalence, pathogenesis and the treatment of neonatal VAP and to remind what can be done to prevent VAP.

Anahtar Kelimeler

Ventilator-associated pneumonia, new born, prevention

Yenidoğan Yoğun Bakım Ünitelerinde Ventilatör İlişkili Pnömoni

Öz

Mekanik ventilasyonun önemli bir kompilikasyonu olan ventilatör ilişkili pnömoni VİP yenidoğan yoğun bakım ünitelerinde YYBÜ ikinci en sık görülen hastane kaynaklı enfeksiyondur. Yoğun bakımda yatış süresini ve mortaliteyi artırabilir. Tanı, klinik ve radyolojik bulguların değerlendirilmesiyle konur. Yenidoğan döneminde alt hava yollarından kontamine olmamış örneklerin alınması ve mikrobiyolojik incelemelerin yapılması zordur. Bu nedenle antibiyotik tedavisi sıklıkla ampirik olarak başlanır. Son yıllarda non-bronkoskopik ya da kör bronkoalveoler lavaj gibi tekniklerle alınan örneklerin kültür ve mikroskobik incelemelerinin yenidoğan VİP tanısında duyarlılık ve hassasiyettinin yüksek olduğu gösterilmiştir. Bu teknikler yenidoğan döneminde de uygulanabilir Ventilatör ilişkili pnömoni önlenebilir bir hastane kaynaklı enfeksiyondur. Ventilatör ilişkili pnömoni hızını azaltmaya yönelik uygulamaların bir paket içinde toplanması ve eksiksiz uygulanması “bundle” yaklaşımı olarak adlandırılır. “Bundle” uygulaması ile VİP hızında anlamlı bir azalma sağlanabilir. Bu derleme, neonatal VİP’in yaygınlığı, patogenezi ve tedavisi konusunda güncel bilgiler sunmayı ve VİP’i önlemeye yönelik yapılabilecekleri hatırlatmayı amaçlamaktadır.

Anahtar Kelimeler

Ventilatör ilişkili pnömoni, yenidoğan, önleme

Kaynakça

• Goldsmith JP, Edward HK. In Assisted Ventilation of the Neonate.Chapter 24, 5th ed. St.louis, Missouri: Saunders, Elsevier, 2011
• Petdachai W. Ventilator-associated pneumonia in a new born intensive care unit. Southeast Asian J Trop Med public Health. 2004;35:724–9.
• Foglia E, Meier MD, Edward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Micro Boil Rev.2007;20:409– 25.
• van der Zwet WC, Kaiser AM, van Elburg RM, Berkhof J, Fetter WP, Parlevliet GA, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect. 2005;61:300-11.
• Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR. Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units. Am J Infect Control 2001;29:152–7.
• Yuan TM, Chen LH, Yu H. Risk factors and outcomes for ventilator- associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007;35:334–8.
• Cordero L, Ayers LW, Miller RR, Seguin JH, Coley BD. Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants. Am J Infect Control. 2002;30:32-9.
• Yalaz M, Altun-Köroğlu O, Ulusoy B, Yildiz B, Akisu M, Vardar F, et al. Evaluation of device-associated infections in a neonatal intensive care unit. Turk J Pediatr. 2012;54:128-35.
• Bolat F, Uslu S, Bülbül A, Cömert S, Can E, Baş EK, et al. Hospital acquired bloodstream infections in neonatal intensive care unit. Turk Arch Pediatr 2011;46:137-43
• Garland JS. Strategies to prevent ventilator-associated pneumonia in neonates. Clin Perinatol. 2010;37:629-43.
• Cardeñosa Cendrero JA, Solé-Violán J, Bordes Benítez A, Noguera Catalán J, Arroyo Fernández J, et al. Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 1999;116:462–70.
• Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics. 2003;112:1283-9.
• Sole ML, Poalillo FE, Byers JF, Ludy JE. Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study. Am J Crit Care 2002;11:141–9.
• Tan B, Xian-Yang X, Zhang X, Peng-Zhou X, Wang P, Xue J, et al. Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: a meta-analysis. Am J Infect Control. 2014;42:902-10.
• Cernada M, Aguar M, Brugada M, Gutiérrez A, López JL, Castell M, et al. Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique: a prospective observational study. Pediatr Crit Care Med. 2013;14:55-61.
• Morris AC, Kefala K, Simpson AJ, Wilkinson TS, Everingham K, Kerslake D, et al. Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia. Thorax. 2009;64:516-22.
• Cordero L, Sananes M, Dedhiya P, Ayers LW. Purulence and gram- negative bacilli in tracheal aspirates of mechanically ventilated very low birth weight infants. J Perinatol 2001;21:376–81.
• Katayama Y, Minami H, Enomoto M, Takano T, Hayashi S, Lee YK. Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated pneumonia in extremely preterm neonates. J Perinatol. 2010;30:270-4.
• O’Horo JC, Thompson D, Safdar N. Is the gram stain useful in the microbiologic diagnosis of VAP? A meta-analysis. Clin Infect Dis. 2012;55:551-61.
• Balthazar AB, Von Nowakonski A, De Capitani EM, Bottini PV, Terzi RG, Araşjo S. Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy. Braz J Med Biol Res. 2001;34:993-1001.
• Fabregas N, Ewig S, Torres A, El-Ebiary M, Ramirez J, de La Bellacasa JP, et al. Clinical diagnosis of ventilator-associated pneumonia revisited: comparative validation using immediate postmortum lung biopsies. Thorax 1999;54:867–73.
• Köksal N, Hacimustafaoğlul M, Celebi S, Ozakin C. Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns. Turk J Pediatr. 2006;48:213-20.
• Celik IH, Oguz SS, Demirel G, Erdeve O, Dilmen U. Outcome of ventilator- associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review. Eur J Pediatr. 2012;171:311-6.
• Sharek PJ, Benitz WE, Abel NJ, Freeburn MJ, Mayer ML, Bergman DA. Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU. J Perinatol. 2002;22:137-43.
• Rogers E, Alderdice F, McCall E, Jenkins J, Craig S. Reducing nosocomial infections in neonatal intensive care. J Matern Fetal Neonatal Med. 2010;23:1039-46.
• Hentschel J, Brüngger B, Stüdi K, Mühlemann K. Prospective surveillance of nosocomial infections in a Swiss NICU: low risk of pneumonia on nasal continuous positive airway pressure? Infection. 2005;33:350-5.
• Torres A, Gatell JM, Aznar E, el-Ebiary M, Puig de la Bellacasa J, González J, et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 1995;152:137–41.
• Centers for Disease Control and Prevention (CDC). Guidelines for prevention of healthcare-associated pneumonia. MMWR Recomm Rep 2004;53:1–36.
• Chlebicki MP, Safdar N. Topical chlorhexidine for prevention of ventilatorassociated pneumonia: a meta-analysis. Crit Care Med 2007;35:595–602
• Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol. 2000;20:151-6.
• Taylor JE, Hawley G, Flenady V, Woodgate PG. Tracheal suctioning without disconnection in intubated ventilated neonates. Cochrane Database Syst Rev. 2011;7:CD003065.
• Craven DE, Goularte TA, Make BJ. Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia? Am Rev Respir Dis.1984;129:625-8.
• Samransamruajkit R, Jirapaiboonsuk S, Siritantiwat S, Tungsrijitdee O, Deerojanawong J, Sritippayawan S, et al. Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU. J Crit Care. 2010;25:56-61.
• Yildizdas D, Yapicioglu H, Yilmaz HL. Occurrence of ventilator- associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care. 2002;17:240-5.
• Graham PL, Begg MD, Larson E, Della-Latta P, Allen A, Saiman L. Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J 2006;25:113–7.
• Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf. 2005;31:243-8.
• Youngquist P, Carroll M, Farber M, Macy D, Madrid P, Ronning J, et al. Implementing a ventilator bundle in a community hospital. Jt Comm J Qual Patient Saf. 2007;33:219-25.
• Rosenthal VD, Rodríguez-Calderón ME, Rodríguez-Ferrer M, Singhal T, Pawar M, Sobreyra-Oropeza M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a multidimensional strategy to reduce ventilator-associated pneumonia in neonatal intensive care units in 10 developing countries. Infect Control Hosp Epidemiol. 2012;33:704-10.
• Zhou Q, Lee SK, Jiang SY, Chen C, Kamaluddeen M, Hu XJ, et al. Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit. Am J Infect Control. 2013;41:1059-64.