Background: Ventilator-associated pneumonia (VAP) is an important condition in the field of critical care medicine. It is the second most common nosocomial infection in pediatric intensive care unit causing an increase in the rate of mortality, morbidity and hospital cost. Despite the advances in medicine, literature have a poor agreement on the consensus and gold standard in its diagnosis. Thus, this study aimed to compare the use of clinical criteria by CDC with the CPIS.
Method: Children aged 0 to 18 years old suspected with VAP were included in the study. The patients were evaluated for the clinical criteria and CPIS on the day of inclusion and after 72 hours for re-evaluation. Endotracheal tube aspirate culture was used as the reference standard for this study. The accuracy of clinical criteria and CPIS in detecting ventilator-associated pneumonia were computed and expressed in terms of its sensitivity, specificity, PPV and NPV.
Results: Eighty-eight patients admitted in the Intensive Care Unit were enrolled in the study from September 2016 to January 2017. Majority of the population belonged to age group of 0 to 1 year of which 16 neonates were diagnosed to have VAP through endotracheal tube aspirate culture. There were more males for each group than females. Cyanotic heart disease was the predominating cardiac lesion. Young age was noted to be associated with VAP with a p value of 0.04. On the day of inclusion, CDC clinical criteria had a sensitivity of 91.3% and specificity of 80%. CPIS showed a sensitivity and specificity of 69.6% and 50.8%, respectively. After 72 hours, the sensitivity and specificity of CDC clinical criteria was 77.8% and 95.9%, respectively. While CPIS had a sensitivity of 77.8% and of specificity 79.6%.
Conclusion: This study has shown that the CDC clinical criteria is more accurate in the diagnosis of VAP among pediatric patients in the intensive care unit not only on initial assessment but also on follow-up after 72 hours.