Incidence, Mortality, and Determinants of Ventilator-Associated Pneumonia Among Pediatric Patients at the National Referral Hospital, Bhutan: A Prospective Cohort Study.

Background: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care units (PICUs). In Bhutan, baseline data on VAP are limited. This study aimed to determine the incidence, mortality, and factors associated with VAP among mechanically ventilated pediatric patients at the Jigme Dorji Wangchuck (JDW) National Referral Hospital. Methods: A prospective cohort study was conducted in the PICU of JDW National Referral Hospital from January 1, 2019 to December 31, 2019. Children aged 1 month to 12 years who required mechanical ventilation for more than 48 h were included. Demographic, clinical, and outcome data were collected and analyzed using SPSS version 23. Logistic regression analysis was performed to identify factors associated with VAP. Results: Among 92 mechanically ventilated patients, 13 developed VAP, corresponding to an incidence of 20.5 per 1000 ventilator days. Infants accounted for 79.3% of the cohort, and 57.6% were female. The most common admitting diagnoses were central nervous system infections (57.6%), congenital heart disease (35.9%), and pulmonary diseases (27.2%). The predominant pathogens were Conclusions: The incidence of VAP in this setting is high, with a notably elevated mortality among ventilated pediatric patients. The findings likely reflect the severity of illness and referral patterns in a national referral center. Strengthening infection prevention practices, optimizing ventilator care, and improving early referral and critical care capacity may help reduce VAP incidence and improve outcomes.