• Roberto J A Casado, Maria Júlia G de Mello, Rosana C F de Aragão, Maria de Fátima P M de Albuquerque, and Jailson B Correia.
• Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, Pernambuco, Brazil.
• Crit. Care Med. 2011 Aug 1;39(8):1968-73.

ObjectivesTo determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.DesignProspective cohort study.SettingPediatric intensive care unit with 16 medical and surgical beds in a tertiary teaching hospital in Recife, northeast Brazil.PatientsPatients aged <18 yrs were consecutively enrolled between January 2005 and June 2006 into a cohort set to investigate health care-associated infections. Newborns and patients admitted for surveillance and those staying for <24 hrs were excluded. Patients were followed up daily throughout the stay and until 48 hrs after discharge from the unit.InterventionsNone.Measurements And Main ResultsThis report focuses on health care-associated pneumonia, defined as pneumonia that occurs >48 hrs after admission but that was not incubating at the time of admission, as the primary outcome. Intrinsic and extrinsic variables were prospectively recorded into a standardized form. Statistical analyses, including multivariable logistic regression, were performed in Stata version 9.1. There were 765 eligible admissions. Health care-associated pneumonia occurred in 51 (6.7%) patients with an incidence density of 13.1 episodes/1,000 patient-days. There were 366 (47.8%) patients on mechanical ventilation, of whom 39 (10.7%) presented with ventilator-associated pneumonia with an incidence density of 27.1/1,000 days on ventilation. Longer stay on ventilation (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08), use of gastric tube (OR, 2.88; 95% CI, 1.41-5.87), and of sedatives/analgesics (OR, 2.45; 95% CI, 1.27-4.72) were identified as independent risk factors for healthcare-associated pneumonia.ConclusionIdentification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.

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