{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:03:06Z","timestamp":1789380186938,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ventilator\u2010associated pneumonia (VAP) is a common healthcare\u2010associated 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted in the PICU of JDW National Referral Hospital from January 1, 2019\u00a0to December 31, 2019. Children aged 1 month to 12 years who required mechanical ventilation for more than 48\u2009h 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      (30.8%) and\n                      <jats:italic>Klebsiella species<\/jats:italic>\n                      (23.1%), with over 92% of isolates sensitive to second\u2010generation cephalosporins. Patients with VAP had significantly longer durations of hospitalization, PICU stay, and mechanical ventilation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The overall mortality rate was 72.8%, with higher mortality observed in the non\u2010VAP group compared to the VAP group (78.5% vs. 38.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), likely reflecting survivor bias. Although several factors were associated with VAP in univariable analysis, none remained statistically significant after multivariable adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72840","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:45:28Z","timestamp":1784616328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence, Mortality, and Determinants of Ventilator\u2010Associated Pneumonia Among Pediatric Patients at the National Referral Hospital, Bhutan: A Prospective Cohort Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3216-343X","authenticated-orcid":false,"given":"Tashi","family":"Tshering","sequence":"first","affiliation":[{"name":"Department of Paediatrics Eastern Regional Referral Hospital Mongar Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7324-3028","authenticated-orcid":false,"given":"Yeshey","family":"Dorjey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Eastern Regional Referral Hospital Mongar Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1633-3510","authenticated-orcid":false,"given":"Kuenley","family":"Pedon","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6887-2847","authenticated-orcid":false,"given":"Mimi Lhamu","family":"Mynak","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Jigme Dorji Wangchuck National Referral Hospital Thimphu Bhutan"},{"name":"Office of the President National Medical Service Thimphu Bhutan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"NIH. \u201cVentilator\u2010Associated Pneumonia.\u201d National Library of Medicine2023 accessed March 10 2025 https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507711\/."},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/NICC.70066"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0247832"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2025.05.026"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/PPUL.25929"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/CUREUS.38189"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/IJPAM.IJPAM_61_24"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00134-020-06036-Z\/METRICS"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.37201\/REQ\/S03.06.2022"},{"key":"e_1_2_15_11_1","unstructured":"National Statistical Bureau \u201cNational Statistical Bureau \u201d accessed August 22 2025 https:\/\/www.nsb.gov.bt\/."},{"key":"e_1_2_15_12_1","unstructured":"JDWNRH \u201cJigme Dorji Wangchuck National Referral Hospital Referral Report \u201d2014."},{"key":"e_1_2_15_13_1","unstructured":"JDWNRH.2024. \u201cJDWNRH Annual Report\u20132024 \u201d 1\u2013268 accessed August 19 2025 https:\/\/jdwnrh.gov.bt\/download\/jdwnrh-annual-report-2024\/."},{"key":"e_1_2_15_14_1","unstructured":"OpenEpi.2025. \u201cSample Size for Frequency in a Population.\u201d OpenEpi accessed March 16 2025 https:\/\/www.openepi.com\/SampleSize\/SSPropor.html."},{"key":"e_1_2_15_15_1","unstructured":"CDC.2025\u201cPneumonia (Ventilator\u2010Associated [VAP] and Non\u2010Ventilator\u2010Associated Pneumonia [PNEU]) Event.\u201d National Healthcare Safety Network 1\u201319 accessed March 15 2025 https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/6pscvapcurrent.pdf."},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/ABR.ABR_371_21"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.4266\/ACC.2022.00395"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/S44197-025-00445-3\/TABLES\/5"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.14744\/NCI.2023.90767"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.4314\/EJHS.V31I5.2"},{"key":"e_1_2_15_21_1","first-page":"61","article-title":"Comparison of Morbidity, Mortality, and Costs of VAP Patients With Non\u2010VAP Patients in the Tertiary Referral Hospital of Kerman, Iran","volume":"22","author":"Ahmadipour M.","year":"2023","journal-title":"Tanaffos"},{"key":"e_1_2_15_22_1","first-page":"61","article-title":"Comparison of Morbidity, Mortality, and Costs of VAP Patients With Non\u2010VAP Patients in the Tertiary Referral Hospital of Kerman, 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