Radiographic Presentations of Hospital Acquired Pneumonia in Pediatric ICU

Background: Hospital-acquired pneumonia is a major medical problem even in developed countries. It is the most common nosocomial infection reaching 25% of all infections in the intensive care unit (ICU).

Aim: Aim is to study the radiographic findings of hospital acquired pneumonia in collaboration with laboratory and clinical findings in pediatric intensive care unit.

Patients and Methods: A prospective study on 60 pediatric patients admitted to PICU. Cases were divided into two groups. Group A: 30 cases with clear chest x-ray on admission and developed Hospital Acquired Pneumonia (HAP) after 48 hours. Group B: 30 cases with Community Acquired Pneumonia (CAP) on admission. Both groups were subdivided into mechanically ventilated and non-Mechanically Ventilated (MV and non-MV).

Results: Regarding X-ray in 1st day there was significant increase in CAP compared with HAP in the form of Bronchopneumonia and lobar pneumonia with effusion. X-ray in HAP had significant worsening in 3rd day compared with 1st day in both MV and non-MV groups. Otherwise no difference was found between groups.

Regarding CT Chest, there was statistically significant increase in Bronchopneumonia in non-MV CAP compared with other groups. Also, there was statistically significant increase in Rt. Upper lobar pneumonia in MV HAP compared with other groups. Similarly, there was statistically significant increase in Lt. pleural effusion with underling consolidation collapse of lower lobe in MV HAP compared with other groups. There was statistically significant increase in Rt. pleural effusion with underling consolidation collapse of rt. Lung in non-MV CAP compared with other groups. There was statistically significant increase in Bronchopneumonia with Rt. minimal pneumothorax in MV CAP compared with other groups. Otherwise, there was no significant difference between the studied groups.

Conclusion: Hospital acquired pneumonia was worse radiologically and bacteriologically. Hence, need more time to heal and more aggressive therapy was needed. Clinical pulmonary infection score was predictor for mortality. Predictors for length of stay (LOS) were found total leukocystic count (TLC), Absolute Neutrophilic Count (ANC), ESR and Culture & Sensitivity of bronchial secretions.