Ventilator-associated tracheitis in children: does antibiotic duration matter?

Abstract

BACKGROUND:

The optimal duration of antibiotic therapy for ventilator-associated tracheitis (VAT) has not been defined, which may result in unnecessarily prolonged courses of antibiotics. The primary objective of this study was to determine whether prolonged-course (≥7 days in duration) therapy for VAT was more protective against progression to hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), compared with short-course antibiotics (<7 days in duration). The secondary objective was to determine whether prolonged-course therapy was more likely to result in the acquisition of multidrug-resistant organisms (MDROs) compared with short-course therapy.

METHODS:

We conducted a retrospective cohort study of children ≤18 years of age hospitalized in the intensive care unit and intubated for ≥48 h from January 2007 through December 2009 who received antibiotic therapy for VAT.

RESULTS:

Of the 1616 patients intubated for at least 48 h, 150 received antibiotics for clinician-suspected VAT, although only 118 of these patients met VAT criteria. Prolonged-course antibiotics were not protective against subsequent development of HAP or VAP (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.40-2.91). Factors associated with subsequent MDRO colonization or infection included prolonged-course antibiotic therapy (HR, 5.15; 95% CI, 1.54-7.19), receipt of combination antibiotic therapy (HR, 3.24; 95% CI, 1.54-6.82), and days of hospital exposure prior to completing antibiotic therapy (HR, 1.08; 95% CI, 1.04-1.12).

CONCLUSIONS:

A prolonged course of antibiotics for VAT does not appear to protect against progression to HAP or VAP compared with short-course therapy. Furthermore, prolonged antibiotic courses were associated with a significantly increased risk of subsequent MDRO acquisition.

• Authors: Pranita D Tamma, Alison E Turnbull, Aaron M Milstone, Christoph U Lehmann, Emily R M Sydnor, Sara E Cosgrove
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 52 Issue 11 Pg. 1324-31 (Jun 2011) ISSN: 1537-6591 [Electronic] United States
• PMID: 21540205 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Anti-Bacterial Agents (administration & dosage)
• Child
• Child, Preschool
• Cohort Studies
• Cross Infection (epidemiology, prevention & control)
• Female
• Humans
• Infant
• Intensive Care Units
• Male
• Pneumonia, Ventilator-Associated (epidemiology, prevention & control)
• Respiration, Artificial (adverse effects)
• Retrospective Studies
• Time Factors
• Tracheitis (epidemiology)