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Infect Control Hosp Epidemiol. 2018 Nov 9:1-8. doi: 10.1017/ice.2018.264. [Epub ahead of print]

Variability in antimicrobial use in pediatric ventilator-associated events.

Author information

1
1Department of Population Medicine,Harvard Pilgrim Health Care Institute and Harvard Medical School,Boston,Massachusetts.
2
3Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania,Philadelphia,Pennsylvania.
3
4Division of Critical Care Medicine,Department of Anesthesiology,Critical Care and Pain Medicine,Boston Children's Hospital,Boston,Massachusetts.
4
5Division of Infectious Diseases,Department of Medicine,Boston Children's Hospital,Boston,Massachusetts.
5
6Section of Infectious Diseases,Department of Pediatrics,Rush University Medical Center,Rush Medical College,Chicago,Illinois.
6
7Division of Critical Care Medicine,Department of Pediatrics,Intermountain Primary Children's Hospital and University of Utah,Salt Lake City,Utah.
7
8Division of Pediatric Critical Care,Department of Pediatrics,Rainbow Babies and Children's Hospital,Cleveland,Ohio.
8
9Department of Neonatology,Beth Israel Deaconess Medical Center,Boston,Massachusetts.

Abstract

OBJECTIVE:

To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).

DESIGN:

Descriptive retrospective cohort with nested case-control study.

SETTING:

Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.PatientsChildren≤18 years ventilated for≥1 calendar day.

METHODS:

We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.

RESULTS:

Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20-67%; PICU, 0-70%; and NICU, 0-43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.

CONCLUSIONS:

Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.

PMID:
30409233
DOI:
10.1017/ice.2018.264

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