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Abstract
Purpose
Ventilator—associated pneumonia (VAP) is a serious threat in critically ill pediatric patients. Data regarding Stenotrophomonas ma/— tophilia VAP in pediatric population is limited. We evaluated the clinical data of S. maltophilia associated VAP in critically ill pediatric patients.
Methods
A retrospective chart review was performed in pediatric patients 18 years old or younger who developed 5. maltophilia associated VAP at Samsung Medical Center, Seoul Korea from January 2008 to December 2012.
Results
A total of 31 patients were identified 5. ma/toph/Via associated VAP. Median age was 8 months (range, 0.5 month to 16.6 years) and 13 patients were male (40.6%). Underlying illnesses were cardiologicdiseases (n:11, 34.4%), hematologic oncologic malignancies (n27, 25%), neurologic diseases (n=4, 12.5%), pulmonary diseases (n23, 9.4%), and others (n=4, 12.5%). The median duration of ventilator use before 5. maltophilia VAP diagnosis was 14 days (range, 4-256 days). Overall mortality at 30 days was 12.5% (4/32).
REFERENCES
1. Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diag—nosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis. 2013; 26:140–50.
2. Stephen WP, Alison TK, Ken K, Robert J, Louise V, Charlene G, et al. Health care—associated infections among critically ill children in the US, 2007-2012. Pediatrics. 2014; 134:705–12.
3. Dudeck MA, Edwards IR, Allen-Bridson K, Gross C, Malpiedi PI, Peterson KD, et al. National healthcare safety network report, data summary for 2013, device-associated module. Am J Infect Control. 2015; 43:206–21.
4. Foglia E, Meier MD, Elward A. Ventilator—associated pneu—monia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007; 20:409–25.
5. Venkatachalam V, Hendley Jo, Willson DF. The diagnostic dilemma of ventilator—associated pneumonia in critically ill children. Pediatr Crit Care Med. 2011; 12:286–96.
6. Mariki P, Rellosa N, Wratney A, Stockwell D, Berger J, Song X, et al. Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia. Am J Infect Control. 2014; 42:1079–83.
7. Willson DF, Conaway M, Kelly R, Hendley JO. The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. Pediatr Crit Care Med. 2014; 15:299–305.
8. Lakatos B, Jakopp B, Widmer A, Frei R, Pargger H, Elzi L, et al. Evaluation of treatment outcomes for Stenotrophomonas maltophilia bacteraemia. Infection. 2014; 42:553–8.
9. Ning BT, Zhang CM, Liu T, Ye S, Yang ZH, Chen ZJ. Patho—genic analysis of sputum from ventilator-associated pneu—monia in a pediatric intensive care unit. Exp Ther Med. 2013; 5:367–71.
10. Ko HK, Yu WK, Lien TC, Wang JH, Slutsky AS, Zhang H, et al. Intensive care unit—acquired bacteremia in mechanically ventilated patients: clinical features and outcomes. PLoS One. 2013; 8::e83298.
11. Brooke IS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012; 25:2–41.
12. Araoka H, Fujii T, Izutsu K, Kimura M, Nishida A, Ishiwata K, et al. Rapidly progressive fatal hemorrhagic pneumonia caused by Stenotrophomonas maltophilia in hematologic malignancy. Transpl Infect Dis. 2012; 14:355–63.
13. Lee MR, Wang HC, Yang CY, Lin CK, Kuo HY, Ko JC, et al. Clinical characteristics and outcomes of patients with pleural infections due to Stenotrophomonas maltophilia at a medical center in Taiwan, 2004-2012. Eur J Clin Microbiol Infect Dis. 2014; 33:1143–8.
14. Bouza E, Granda MJ, Hortal J, Barrio JM, Cercenado E, Mufioz P. Pre—emptive broad—spectrum treatment for ventilator-as—sociated pneumonia in high—risk patients. 2013; 39:1547–55.
15. Centers for Disease Control and Prevention. National Health—care Safety Network. Surveillance for ventilator-associated pneumonia (VAP). Available at. http://www.cdc.g0V/nhsn/PDFs/pscManual/6pchAPcurrent.pdf. [accessed on 20 Apr 2015].
16. Centers for Disease Control and Prevention. National Health—care Safety Network. Surveillance for ventilator—associated pneumonia (VAP). Available at. http://WWW.cdc.g0V/nhsn/acute—care—hospital/vap/index.html. [accessed on 20 Apr 2015].
17. Casado RJ, de Mello MJ, de Aragao RC, de Albuquerque MF, Correia JB. Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit. Crit Care Med. 2011; 39:1968–73.
18. Gupta S, Boville BM, Blanton R1, Lukasiewicz G, Wincek J, Bai C, et al. A multicentered prospective analysis of diagnosis, risk factors, and outcomes associated with pediatric venti—lator—associated pneumonia. Pediatr Crit Care Med. 2015; 16:e65–e73.
19. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator—associated pneumonia: a meta—analysis of individual patient data from randomised prevention studies. The Lancet Infec—tious Diseases. 2013; 13:665–71.
20. Brooke JS. New strategies against Stenotrophomonas maltophilia: a serious worldwide intrinsically drug—resistant opportunistic pathogen. Anti Infect Ther. 2014; 12:1–4.
Table 1.
Characteristics of Patients
Table 2.
ICU and Ventilator Care in Patients with S. maltophilia associated VAP
Table 3.
Risk Factors at Onset of S. maltophilia associated VAP
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