Pediatric Mechanical Ventilation

Ventilator-Associated Tracheitis and Antibiotic Duration

William R. Jarvis, MD

Antimicrobial use in intensive care units is a major driver for multidrug-resistant organisms. One of the most common situations in which antibiotics are misused is in patients on mechanical ventilation. In a recent study, Tamma and colleagues,^[1] asked the question, "Does the length of antibiotic therapy for ventilator-associated tracheitis (VAT) in pediatric patients make a difference?" They included all patients less than 18 years of age in their neonatal intensive care unit or pediatric intensive care unit who were on ventilation for at least 48 hours.
They defined VAT as fever or hypothermia, leukocytosis or leukopenia, a Gram stain of secretions showing moderately heavy polymorphonucleocytes, moderate or heavy bacterial growth, and no radiologic evidence of a new lung infiltrate. They enrolled 1616 patients who were intubated for more than 48 hours.
One hundred-fifty of those patients received antibiotics for what clinicians suspected was VAT. Only 118 patients met the investigators' definition of VAT. They found that prolonged courses of antibiotics, defined as 7 days or more, were not protective against progression of either hospital-associated pneumonia or ventilator-associated pneumonia. In fact, factors for multidrug-resistant colonization or infection included a prolonged course of antibiotics, receipt of combination antibiotics, and days of hospital exposure before completing the antibiotic therapy.
This study shows that there is no need for clinicians to use a course of antibiotics longer than 7 days in patients with documented VAT. By reducing antibiotic exposures, they reduce the opportunity for these patients to become colonized with multidrug-resistant organisms and subsequently develop infections with those organisms, which would be much more serious than the VAT they started with. Hopefully, this study will help reduce antibiotic exposures in our neonatal and pediatric intensive care patients.

http://www.medscape.com/viewarticle/755339