Endotracheal Aspirate and Ventilator-Associated Pneumonia in Neonates: Revisiting an Age-Old Debate

Objectives To explore the utility of endotracheal aspirates (ETA) for analyzing microbiological yield, incidence, risk factors for VAP, and clinically relevant outcomes. Methods Ventilated neonates suspected to have VAP were studied prospectively; they were classified as VAP or No VAP based on a predefined combination of clinical, radiological, and laboratory criteria. The microbiological yield from blood and ETA cultures was analyzed. Results Of 165 neonates who were ventilated for >48 h, 65 were suspected of having VAP. Thirty-six (22.9%) were classified as VAP. Microbiological agents could be identified in 31 cases (86.1%) by ETA/blood cultures. Acinetobacter sp was the common organism identified. Duration of ventilation, and a higher number of reintubations before suspicion of VAP were significant risk factors for VAP. Positive ETA culture was associated with a greater duration of oxygen therapy and ventilation days after suspicion of VAP. Conclusions The commonest culture yield from ETA in those suspected to have VAP was gram-negative bacilli. Duration of ventilation and reintubations were identified as significant risk factors for VAP. These are potentially modifiable factors. Positive ETA culture was associated with longer needs for respiratory supports. Negative ETA culture might encourage clinicians to stop antibiotics.

Automated summary

The utility of endotracheal aspirates (ETA) for analyzing microbiological yield, incidence, risk factors for ventilator-associated pneumonia (VAP), and clinically relevant outcomes were explored in this study. It was found that gram-negative bacilli were the most common culture yield from ETA in neonates suspected to have VAP. Duration of ventilation and reintubations were identified as significant risk factors for VAP, which could be potentially modified to reduce VAP incidence. Positive ETA culture was associated with longer needs for respiratory supports, while negative ETA culture might encourage clinicians to stop antibiotics.