Evaluation of Ventilator-associated Pneumonia Approaches in Pediatric Intensive Care Units in Türkiye

Objective: The purpose of this study was to collect data on the management of ventilator-associated pneumonia (VAP) in pediatric intensive care units (PICU) in Türkiye and to determine the need for new national pediatric VAP guidelines. Methods:In this multicenter cross-sectional study, an online questionnaire was disseminated via email to PICUs in various cities across Türkiye.One person at each PICU, namely, the clinician who made the treatment decisions, completed the questionnaire.The VAP diagnosis and treatment algorithms of the PICUs were analyzed using the data obtained from the questionnaires.Results: Of the initial 32 PICUs, 30 units in 19 cities completed the questionnaire.The average number of beds in the units was 13.13±6.16,and the number of beds per nurse per shift was 2.13±0.57.The mean duration of mechanical ventilation was 5.8±4.2days.The mean VAP frequency was 2.81% and the mean VAP rate was 5.04 per 1000 ventilator day.Distal airway culture sampling was performed in 86.7% of the units before antibiotic treatment was initiated.The most common agent was Pseudomonas aeruginosa, followed by Klebsiella pneumonia and Acinetobacter baumannii.When the resistance status of the isolates was analyzed, anti-pseudomonal penicillin resistance was 81.2%, antipseudomonal cephalosporin resistance was 84.5% for Pseudomonas aeruginosa; cefepime and ceftazidime resistance was 80.5% for Klebsiella pneumonia, and carbapenem resistance was 47.5% for Acinetobacter baumannii.A nurse-bed ratio >2 made a significant difference in the VAP rates between the PICUs (p<0.05). Conclusion:Consensus exists regarding the need to reduce VAP in PICUs in Türkiye, and up-to-date national guidelines are essential to maximize the efficiency of PICUs.