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Variability in antimicrobial use in pediatric ventilator-associated events

Published online by Cambridge University Press:  09 November 2018

Manjiree V. Karandikar ,
Susan E. Coffin Open the ORCID record for Susan E. Coffin [Opens in a new window] ,
Gregory P. Priebe ,
Thomas J. Sandora ,
Latania K. Logan Open the ORCID record for Latania K. Logan [Opens in a new window] ,
Gitte Y. Larsen ,
Philip Toltzis ,
James E. Gray ,
Michael Klompas  and
Julia S. Sammons
...Show all authors
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
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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
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 32 - 39
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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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;44:14–22.Google 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;17:157–164.Google 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;43:2446–2451.Google Scholar
5. Corcoros, NM, Priebe, GP, Logan, LK, et al. A pediatric approach to ventilator-associated events. Infect Control Hosp Epidemiol 2017;38:327–333.Google 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:e536–e545.Google Scholar
7. Stenehjem, E, Hersh, AL, Sheng, X, et al. Antibiotic use in small community hospitals. Clin Infect Dis 2016;63:1273–1280.Google Scholar
8. Schulman, J, Dimand, RJ, Lee, HC, Duenas, GV, Bennett, MV, Gould, JB. Neonatal intensive care unit antibiotic use. Pediatrics 2015;135:826–833.Google Scholar
9. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:1067–1073.Google Scholar
10. Klompas, M, Kleinman, K, Murphy, MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol 2014;35:502–510.Google Scholar
11. Tzialla, C, Borghesi, A, Serra, G, Stronati, M, Corsello, G. Antimicrobial therapy in neonatal intensive care unit. Ital J Pediatr 2015;41:27.Google Scholar
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;170:1181–1187.Google Scholar
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;181:289–293.Google Scholar
14. Bradley, JS. Considerations unique to pediatrics for clinical trial design in hospital-acquired pneumonia and ventilator-associated pneumonia. Clin Infect Dis 2010;51:S136–S143.Google Scholar
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;15:299–305.Google 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;37:1162–1166.Google Scholar
17. Klompas, M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Cur Infect Dis Rep 2014;16:430.Google Scholar
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