Longer duration of mechanical ventilation was found to be associated with ventilator-associated pneumonia in children aged 1 month to 12 years in India.

OBJECTIVES: To determine primarily (1) the incidence of ventilator-associated pneumonia (VAP) among ventilated patients aged 1 month to 12 years and secondarily (2) the risk factors for VAP and (3) common organisms causing VAP. STUDY DESIGN AND SETTING: Prospective study in a tertiary care center in India. Consecutive ventilated patients aged ≥1 month and ≤12 years and requiring mechanical ventilation (MV) for ≥48 hours were included after written informed parental consent. For the diagnosis of VAP, National Nosocomial Infections Surveillance System criteria of 1996 were used. RESULTS: Incidence of VAP among patients aged 1 month to 12 years was 36.2% (38/105; 95% confidence interval [CI]: 27, 46). In unconditional logistic regression analysis controlling for the presence of underlying illnesses, risk factor for VAP was >4 days of MV (adjusted odds ratio, 3.76; 95% CI: 1.41, 10.02; P = 0.008). Reintubation within 72 hours of extubation and more than two attendants at the time of recruitment showed increased tendency for the development of VAP but did not reach statistical significance. Endotracheal and endobronchial aspirates were positive for organism in 19.05% (20/105) and 37.14% (39/105) of patients, respectively. CONCLUSION: Almost one-third of ventilated patients develop VAP. Vigilance for the development of VAP has to be kept on those requiring >4 days of MV. Klebsiella and Staphylococcus aureus were common bacterial isolates in such patients.

Epidemiology and microbiology of nosocomial pediatric candidemia at a northern Indian tertiary care hospital.

The availability and aggressive use of chemotherapeutic and immunosuppressive agents as well as broad-spectrum antibacterial agents have created a large population of patients who are at increased risk of acquiring infections with fungal organisms, especially Candida species. Present work was undertaken to study the epidemiology and microbiology of candidemia and Candida colonization in hospitalized children. A total of 323 suspected cases of septicemia were enrolled, of which blood culture from 7.4% subjects was positive for Candida species. In total, 57.3% subjects were colonized by Candida species at least at one of the tested sites. Of 337 isolates, 24.3, 71.5, 2.9, 0.59, and 0.59% were Candida albicans, Candida tropicalis, Candida krusei, Candida kefyr, and Candida lusitaniae, respectively. Antifungal susceptibility results show that fluconazole, itraconazole, and amphotericin B resistance is prevalent in 18.2, 2.4, and 3.6% of C. albicans isolates, and 21.1, 4.6, and 0.04% of C. tropicalis isolates, respectively. In a large number of cases, source of blood infection was patient's own colonizers, as shown by genetic matching. It was also noted that some strain types are circulating within the ward. High prevalence of non-albicans candidemia with high resistance to fluconazole is prevalent in North Indian hospitalized children.

Effectiveness of 3-day amoxycillin vs. 5-day co-trimoxazole in the treatment of non-severe pneumonia in children aged 2-59 months of age: a multi-centric open labeled trial.

This cluster randomized, open labeled trial was conducted to compare the effectiveness of 3 days of oral amoxycillin and 5 days of co-trimoxazole treatment in terms of clinical failure in children with World Health Organization (WHO) defined non-severe pneumonia in primary health centers in rural India. Participants were children aged 2-59 months with WHO defined non-severe pneumonia, with or without wheeze, who were accessible to follow up. From seven primary health centers in each arm, 2009 cases were randomized, 993 and 1016 in treatment with amoxycillin and co-trimoxazole, respectively. Fever was present in 1247 (62.1%) and wheeze in 443 (22.1%). There was good adherence and low loss to follow-up. Clinical failure on amoxycillin and co-trimoxazole on intention to treat analysis was 137 and 97, respectively (absolute difference = 0.04, 95% confidence interval: - 0.035-0.12). We conclude that there was no difference in effectiveness of oral co-trimoxazole or amoxycillin in treating non-severe pneumonia.