405 - Incidence, Risk Factors, and Antibiotic Use in Ventilator Associated Pneumonia in Very Low Birth Weight Infants– Experience at a Single Level III Neonatal Intensive Care Unit

Poster Number: 405
Publication Number: 405.334

Jane Huang, University of Southern California/Keck School of Medicine of USC, MONTCLAIR, CA, United States; Mikhaela Cielo, MCA Clinic LAC+USC, Los Angeles, CA, United States; Lorayne Barton, LAC+USC Medical Center, Los Angeles, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States; Rowena Cayabyab, University of Southern California/LAC+USC Medical Center, Los Angeles, CA, United States

Background: Ventilator associated pneumonia (VAP) is a common hospital acquired infection in neonates on mechanical ventilation. Incidence of VAP varies from 2.7 to 10.9 episodes per 1,000 ventilator days and variation may be due to lack of consensus in the diagnosis of VAP in neonates. Diagnosing neonatal VAP can be challenging as other disease processes such as evolving bronchopulmonary dysplasia (BPD), may have similar clinical and radiographic presentation leading to antibiotic use. 

Objective: The primary objective of this study was to determine the incidence, risk factors, and antibiotic use of VAP in VLBW infants.

Design/Methods: Retrospective study of all intubated VLBW infants admitted to neonatal intensive care unit at LAC+USC Medical Center who had routine TA cultures obtained from July 2015 to July 2021. Neonatal and maternal demographics, clinical course, antibiotic use, radiology reports and laboratory results including microbiology and hematology were collected.  Infants were grouped into no VAP, suspect VAP and confirmed VAP. VAP was defined according to modified CDC criteria for infants less than 1 year old. Suspected VAP was used if neonate received antibiotic treatment for positive TA culture but did not meet VAP criteria. No VAP was used when neonates did not receive antibiotic treatment for positive TA cultures.

Results: A total of 87 intubated VLBW infants were included. The incidence of confirmed VAP was 7.1 per 1,000 ventilator days. There was no significant difference in birth weight, gestational age, gender, mode of delivery, rate of prolonged rupture of membranes, maternal GBS colonization and intrauterine inflammation and infection between the three groups. Infants who had suspected and confirmed VAP had a higher rate of maternal receipt of antenatal steroids, surfactant administration, longer days of intubation and length of stay (Table). Infants with suspected VAP were exposed to antibiotics equally (median of 10 days) compared to confirmed VAP. There were 27/87 (31%) infants who did not meet the diagnostic criteria for VAP but had tracheal colonization and exposed to antibiotics.

Conclusion(s): VAP is associated with prolonged use of invasive mechanical ventilation in VLBW infants. Obtaining routine TA culture can increase antibiotic exposure in these infants. The challenge and inconsistency in the diagnosis of VAP in neonates can also lead to unnecessary use of antibiotics. Avoiding routine TA culture and attempts to extubate early and use of non-invasive ventilation should be discussed daily in the management of these critically ill infants.