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Variability in antimicrobial use in pediatric ventilator-associated events

  • Manjiree V. Karandikar (a1) (a2), Susan E. Coffin (a3), Gregory P. Priebe (a4) (a5), Thomas J. Sandora (a5), Latania K. Logan (a6), Gitte Y. Larsen (a7), Philip Toltzis (a8), James E. Gray (a9) (a10), Michael Klompas (a1) (a11), Julia S. Sammons (a3), Marvin B. Harper (a5), Kelly Horan (a1), Matthew Lakoma (a1), Noelle M. Cocoros (a1) and Grace M. Lee (a1) (a12)...

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.

Copyright

Corresponding author

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

Footnotes

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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

Footnotes

References

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