Variability in antimicrobial use in pediatric ventilator-associated events

• Published in: Infection control and hospital epidemiology Vol. 40; no. 1; pp. 32 - 39
• Main Authors: Karandikar, Manjiree V, Coffin, Susan E, Priebe, Gregory P, Sandora, Thomas J, Logan, Latania K, Larsen, Gitte Y, Toltzis, Philip, Gray, James E, Klompas, Michael, Sammons, Julia S, Harper, Marvin B, Horan, Kelly, Lakoma, Matthew, Cocoros, Noelle M, Lee, Grace M
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01-01-2019
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Antimicrobial agents; Antimicrobial Stewardship - organization & administration; Child; Child, Preschool; Congenital diseases; Diagnostic tests; Disease control; Female; Gestational age; Hospital Mortality - trends; Hospitals; Hospitals - statistics & numerical data; Humans; Infant; Infant, Newborn; Intensive care; Intensive Care Units - classification; Intensive Care Units - statistics & numerical data; Laboratory tests; Male; Medical laboratories; Nursing; Ostomy; Pediatrics; Pneumonia, Ventilator-Associated - diagnosis; Pneumonia, Ventilator-Associated - drug therapy; Respiration, Artificial - adverse effects; Retrospective Studies; Surveillance; United States - epidemiology; Ventilation; Ventilators; United States
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2018.264

To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
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.
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.
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.
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.