EC Pulmonology and Respiratory Medicine

Introduction: Hospital-acquired pneumonia (HAP) is one of the most common complications among hospitalized children. This study aimed to determine the epidemiology and risk factors of HAP in the tertiary pediatric hospital in Tbilisi, Georgia.

Methods: The study included pediatric patients admitted to the Iashvili Central Children's Hospital from March 2023 to January 2024. The following data were recorded: age, sex, hospital ward, and risk factors, including comorbid disease, Hb<10 g/dL, pH<7.35, invasive techniques, surgery, hospital admission in the previous month, and interval from admission to presentation of HAP.

Results: The study was performed on 36 patients with a median age of 36 months. Most of the patients (58%) were males. The most common causes of the admission were upper respiratory tract infection (9 patients, 25%), fever (7 patients, 19%), and bronchitis (5 patients, 14%). Seventeen patients (47%) had histories of hospitalizations within the last 30 days. Most cases (20 out of 36) were late-onset HAP. The median time of HAP onset was 8 days. The median length of the hospital stay was 17 days. Twenty-two out of 36 patients experienced a prolonged length of hospital stay of more than ten days. Most of the patients (24 patients, 67%) had comorbidities. The most frequent comorbidities were developmental delay (6 patients) and epilepsy (5 patients). Logistic regression showed a significant relationship between HAP and the presence of comorbidities, prior hospitalization, prolonged hospitalization and anemia.

Conclusion: Early identification of risk factors may be useful in identifying patients at high risk of HAP development.

 Keywords: Nosocomial Infections; Hospital-Acquired Pneumonia; Epidemiology; Risk Factors; Georgia

1. World Health Organization. “Global report on infection prevention and control”. World Health Organization: Geneva, Switzerland (2022): 148.
2. Shetty K. “Hospital-acquired pneumonia (Nosocomial pneumonia) and ventilator-associated pneumonia”. Updated: June 2, 2023 (2024).
3. Giuliano KK., et al. “The epidemiology of non-ventilator hospital-acquired pneumonia in the United States”. American Journal of Infection Control 3 (2018): 322-327.
4. Amodio E., et al. “Adverse outcomes of patients with non-ventilator-associated hospital-acquired pneumonia (nvHAP)-A single centre cohort study”. Infectious Disease Reports 2 (2024): 228-238.
5. Shahid ASMSB., et al. “Risk factors and outcomes of hospital acquired pneumonia in young Bangladeshi children”. Life (Basel)10 (2021): 1030.
6. Olivier C., et al. “Healthcare-associated infections in pediatric and neonatal wards: A point prevalence survey at four South African hospitals”. South African Medical Journal 5 (2018): 418-422.
7. Sopena N., et al. “Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study”. American Journal of Infection Control 1 (2014): 38-42.
8. Kandelaki G., et al. “Nosocomial infections in Tbilisi, Georgia: a retrospective study of microbiological data from 4 major tertiary care hospitals”. Infection Control and Hospital Epidemiology 9 (2011): 933-934.
9. Deryabina A., et al. “Core components of infection prevention and control programs at the facility level in Georgia: key challenges and opportunities”. Antimicrobial Resistance and Infection Control 1 (2021): 39.
10. Kalil AC., et al. “Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society”. Clinical Infectious Diseases 5 (2016): e61-e111.
11. R Core Team. “R: A language and environment for statistical computing”. R Foundation for Statistical Computing, Vienna, Austria (2022).
12. Williams K., et al. “Standard 6: age groups for pediatric trials". Pediatrics3 (2012): S153-S160.
13. Cavalcante SS., et al. "Risk factors for developing nosocomial infections among pediatric patients”. Pediatric Infectious Disease Journal 5 (2006): 438-445.
14. Pourakbari B., et al. “Epidemiology of nosocomial infections in pediatric patients in an Iranian referral hospital”. Journal of Preventive Medicine and Hygiene 4 (2012): 204-206.
15. Asembergiene J., et al. “Nosocomial infections in Lithuania's pediatric intensive care units”. Medicina (Kaunas)1 (2009): 29-36.
16. Alshaikh R., et al. “Factors influencing the length of stay among patients admitted to a tertiary pediatric intensive care unit in Saudi Arabia”. Frontiers in Pediatrics 10 (2022): 1093160.
17. Sahiledengle B., et al. “Incidence and risk factors for hospital-acquired infection among pediatric patients in a teaching hospital: a prospective study in southeast Ethiopia”. BMJ Open12 (2020): e037997.
18. Edwards JD., et al. “Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay”. Critical Care Medicine 7 (2012): 2196-2203.
19. Cotton MF., et al. “Nosocomial infections in black South African children”. Pediatric Infectious Disease Journal 10 (1989): 676-683.
20. Mohamed AA., et al. “Prevalence, clinical profile and risk factors of nosocomial infection in ayder pediatric intensive care unit, Tigray, Ethiopia”. International Journal of General Medicine 15 (2022): 7145-7153.
21. Porto JP., et al. “Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance”. Revista da Sociedade Brasileira de Medicina Tropical 4 (2012): 475-479.
22. Dramowski A., et al. “Burden, spectrum, and impact of healthcare-associated infection at a South African children's hospital”. Journal of Hospital Infection 4 (2016): 364-372.
23. M Patil S. “Hospital-Acquired Pneumonia”. Infectious Diseases”. IntechOpen (2022).
24. Durak C., et al. “Evaluation of nosocomial infections in a tertiary pediatric intensive care unit”. Medical Journal of Bakirkoy 3 (2023): 302-307.
25. Behzadnia S., et al. “Nosocomial infections in the pediatric population and antibiotic resistance of the causative organisms in the north of Iran”. Iranian Red Crescent Medical Journal 2 (2014): e14562.
26. Shahunja KM., et al. “Experience with nosocomial infection in children under 5 treated in an urban diarrheal treatment center in Bangladesh”. Global Pediatric Health 3 (2016): 2333794X16634267.
27. Nurhayati DH., et al. “Risk factors for mortality in children with hospital-acquired pneumonia in Dr. Soetomo General Hospital Surabaya”. Jurnal Respirasi 2 (2021): 46-52.
28. Almazeedi MA., et al. “Pattern and Frequency of Nosocomial Jeddah General Hospital, Saudi Arabia”. Cureus 10 (2023): e47561.
29. Le NK., et al. “High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: a multi-centre point prevalence survey”. Medicine 27 (2016): e4099.
30. Aiken Alexander M., et al. “Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hospital, Kenya: a prospective cohort study”. Lancet9808 (2011): 2021-2027.
31. Yao W., et al. “Risk factors for hospital-acquired pneumonia in hip fracture patients: a systematic review and meta-analysis”. BMC Musculoskeletal Disorders 1 (2024): 6.