Microbiological aetiology of paediatric ventilator-associated pneumonia and risk factors for carbapenem-resistant acinetobacter and Pseudomonas in a tertiary-care hospital in Thailand.

BACKGROUND

Paediatric ventilator-associated pneumonia (VAP) worsens outcomes and mortality. Characterizing local microbiology and resistance patterns is crucial for empirical therapy and guiding targeted infection prevention and control.

OBJECTIVE

This study aimed to determine the aetiology of VAP, identify risk factors associated with VAP caused by carbapenem-resistant (CR) Acinetobacter and Pseudomonas, and assess the clinical burden and outcomes of VAP in paediatric patients.

METHODS

We conducted a retrospective study of patients under 18 years of age diagnosed with VAP between January 2022 and December 2024, using Centres for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) surveillance criteria. Data including demographics, microbiology, and outcomes were retrieved from electronic medical records. Risk factors for CR-VAP were assessed using logistic regression.

RESULTS

A total of 71 VAP patients with 95 episodes, were analysed (median age: 7.1 months [interquartile range {IQR}, 2-63]; 49% male). The VAP incidence rate showed a decreasing trend (9.1 to 4.7 per 1000 ventilator-days, 2022-2024). The median time to VAP onset was 25 days (IQR, 13-51) postintubation. The predominant isolated pathogens were Gram-negative bacteria, specifically Acinetobacter baumannii (22%; 64% CR), Pseudomonas aeruginosa (19%; 56% CR), and Stenotrophomonas maltophilia (19%). Staphylococcus aureus (8%; 21% Methicillin-resistant Staphylococcus aureus [MRSA]) was the most common Gram-positive isolate. Thirteen patients (18%) experienced multiple VAP episodes. The overall 90-day mortality rate was 24%. Prolonged hospitalization was linked to carbapenem-resistant A. baumannii (CRAB) (adjusted odds ratio [aOR], 4.3; 95% confidence interval [CI], 1.36-13.61; P = 0.013), while prolonged intubation was associated with carbapenem-resistant P. aeruginosa (CRPA) (aOR, 6.61; 95% CI, 1.42-30.85; P = 0.016).

CONCLUSION

VAP remains a challenge in the paediatric setting, characterized by a high prevalence of multi-drug-resistant pathogens, particularly CR Acinetobacter and Pseudomonas. Continued surveillance, antimicrobial stewardship, and intensified prevention are essential to reduce VAP burden and improve outcomes.