Abstract / Summary
Summary: 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.