Skip to main content Accessibility help
×
Home
Hostname: page-component-dc8c957cd-fcmtc Total loading time: 0.247 Render date: 2022-01-27T16:43:52.449Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Variability in antimicrobial use in pediatric ventilator-associated events

Published online by Cambridge University Press:  09 November 2018

Manjiree V. Karandikar*
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, San Francisco, California
Susan E. Coffin
Affiliation:
Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
Gregory P. Priebe
Affiliation:
Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
Latania K. Logan
Affiliation:
Section of Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, Illinois
Gitte Y. Larsen
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, Intermountain Primary Children’s Hospital and University of Utah, Salt Lake City, Utah
Philip Toltzis
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
James E. Gray
Affiliation:
Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Section of Neonatology, Children’s Hospital at Dartmouth, Lebanon, New Hampshire
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts,
Julia S. Sammons
Affiliation:
Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
Marvin B. Harper
Affiliation:
Division of Infectious Diseases, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
Kelly Horan
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Matthew Lakoma
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Noelle M. Cocoros
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts Department of Pediatrics, Stanford University School of Medicine, Stanford, California
*
Author for correspondence: Manjiree Karandikar, MD MBS, Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA 94158. E-mail: Manjiree.karandikar@ucsf.edu Or Grace M. Lee, MD MPH, Department of Pediatrics, 300 Pasteur Drive, G-306B, Stanford, CA 94305-5208. Email: GMLee@stanfordchildrens.org

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.

Patients

Children≤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.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Preliminary data and findings were presented at the Society for Healthcare Epidemiology of America (SHEA) Spring Conference on March 29, 2017, in St Louis, Missouri.

Cite this article: Karandikar MV, et al. (2019). Variability in antimicrobial use in pediatric ventilator-associated events. Infection Control & Hospital Epidemiology 2019, 40, 32–39. doi: 10.1017/ice.2018.264

References

1. Ventilator-associated event (VAE) protocol. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf. Published 2016. Accessed March 25, 2017.Google Scholar
2. Corcoros, NM, Klenmen, K, Priebe, GP, et al. Ventilator associated events in neonates and children—a new paradigm. Crit Care Med 2016;44:1422.CrossRefGoogle Scholar
3. Cirulis, MM, Hamele, MT, Stockmann, CR, Bennett, TD, Bratton, SL. Comparison of the new adult ventilator-associated event criteria to the Centers for Disease Control and prevention pediatric ventilator-associated pneumonia definition (PNU2) in a population of pediatric traumatic brain injury patients. Peditr Crit Care Med 2016;17:157164.CrossRefGoogle Scholar
4. Phongjitsiri, S, Coss-bu, J, Kennedy, C, Silva, J, Graf, J, Thammasitboon, S. The Centers for Disease Control and Prevention’s new definitions for complications of mechanical ventilation shift the focus of quality surveillance and predict clinical outcomes in a PICU. Crit Care Med 2015;43:24462451.CrossRefGoogle Scholar
5. Corcoros, NM, Priebe, GP, Logan, LK, et al. A pediatric approach to ventilator-associated events. Infect Control Hosp Epidemiol 2017;38:327333.CrossRefGoogle Scholar
6. Cocoros, NM, Priebe, GP, Gray, JE, et al. Factors associated with pediatric ventilator-associated conditions in six US hospitals: a nested case-control study. Pediatr Crit Care Med 2017;18:e536e545.CrossRefGoogle Scholar
7. Stenehjem, E, Hersh, AL, Sheng, X, et al. Antibiotic use in small community hospitals. Clin Infect Dis 2016;63:12731280.CrossRefGoogle ScholarPubMed
8. Schulman, J, Dimand, RJ, Lee, HC, Duenas, GV, Bennett, MV, Gould, JB. Neonatal intensive care unit antibiotic use. Pediatrics 2015;135:826833.CrossRefGoogle ScholarPubMed
9. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:10671073.CrossRefGoogle ScholarPubMed
10. Klompas, M, Kleinman, K, Murphy, MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol 2014;35:502510.CrossRefGoogle ScholarPubMed
11. Tzialla, C, Borghesi, A, Serra, G, Stronati, M, Corsello, G. Antimicrobial therapy in neonatal intensive care unit. Ital J Pediatr 2015;41:27.CrossRefGoogle ScholarPubMed
12. Ting, JY, Synnes, A, Roberts, A, et al. Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis. JAMA Pediatr 2016;170:11811187.CrossRefGoogle ScholarPubMed
13. Cantey, JB, Huffman, LW, Subramanian, A, et al. Antibiotic exposure and risk for death or bronchopulmonary dysplasia in very low birthweight infants. J Pediatr 2017;181:289293.CrossRefGoogle ScholarPubMed
14. Bradley, JS. Considerations unique to pediatrics for clinical trial design in hospital-acquired pneumonia and ventilator-associated pneumonia. Clin Infect Dis 2010;51:S136S143.CrossRefGoogle ScholarPubMed
15. Wilson, DF, Conaway, M, Kelly, R, Hendley, JO. The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. Pediatr Crit Care Med 2014;15:299305.CrossRefGoogle Scholar
16. Iosifidis, E, Chochliourou, E, Violaki, A et al. Evaluation of the new Centers for Disease Control and Prevention ventilator-associated event module and criteria in critically ill children in Greece. Infect Control Hosp Epidemiol 2016;37:11621166.CrossRefGoogle Scholar
17. Klompas, M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Cur Infect Dis Rep 2014;16:430.CrossRefGoogle ScholarPubMed
18. National Healthcare Safety Network Member’s Meeting (APIC 2018). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/newsletters/nhsn-members-meeting-2018-508.pdf. Published 2018. Accessed August 23, 2018.Google Scholar
3
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Variability in antimicrobial use in pediatric ventilator-associated events
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Variability in antimicrobial use in pediatric ventilator-associated events
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Variability in antimicrobial use in pediatric ventilator-associated events
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *